Abstract
Pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; PIMS-TS) is a novel condition with persistent fever, inflammation, and single or multiorgan dysfunction. We aimed to describe the characteristics of children more severely affected and our clinical approach. We retrospectively collected clinical, treatment, and early outcomes data during a 3-month period in a pediatric intensive care unit (PICU) of a tertiary university hospital in Portugal. Twelve children who fulfilled the Royal College of Pediatrics and Child Health case definition were hospitalized, seven needed PICU admission. Median age was 13 years and three were overweight, with no other comorbidity. All had positive immunoglobulin G antibodies for SARS-CoV-2. All presented with prolonged fever, asthenia, hypotension, and shock. Other prominent symptoms were abdominal complaints and rash. All patients had leukocytosis, neutrophilia, and marked elevation of inflammatory markers. Cardiac involvement was observed in all patients with elevated levels of troponin and B-type natriuretic peptide along with left ventricular hypokinesis. Depressed left ventricular function was observed in four patients. All patients received broad-spectrum antibiotics, intravenous immunoglobulin, methylprednisolone, low-dose aspirin, and vasoactive medications. Four patients received prophylactic enoxaparin. All patients needed supplementary oxygen; however, high-flow oxygen therapy and noninvasive ventilatory support with positive end-expiratory pressure were required in three and two patients, respectively. Five patients required invasive mechanical ventilation. The mean duration of PICU stay was 7.1 days. The median Pediatric Risk of Mortality-III score was 9 and no mortality was observed. PIMS-TS demands a prompt and multidisciplinary approach. Risk factors, best clinical pathway, and long-term complications are still unknown.