Multisistemik İnflamatuvar Sendrom (MIS-C) Olgularının Klinik Özelliklerinin ve Kardiyolojik Bulgularının Değerlendirilmesi

Year 2023, Volume: 45 Issue: 2, 236 - 244, 15.03.2023

Yalçın Kara , Mahmut Can Kızıl , Gürkan Bozan , Eylem Kıral , Ayşe Sülü , Pelin Kosger , Ömer Kılıç , Birsen Ucar , Ener Dınleyıcı, Md

https://doi.org/10.20515/otd.1183749

Abstract

Çocuklarda multisistemik inflamatuvar sendrom (MIS-C), COVID-19 enfeksiyonu sonrası gelişen, çoklu organ tutulumuyla giden hiperinflamasyonla karakterize bir hastalık tablosudur. Bu çalışmada, MIS-C olgularının klinik özelliklerinin, kardiyolojik bulgularının ve kardiyak manyetik rezonans görüntüleme (MRG) sonuçlarının değerlendirilmesi amaçlanmıştır. Çalışmaya Eskişehir Osmangazi Üniversitesi Tıp Fakültesi’nde, Kasım 2020-Haziran 2022 tarihleri arasında takip edilen MIS-C tanılı 31 olgu dahil edildi. Olguların klinik, epidemiyolojik özellikleri ve kardiyolojik bulguları retrospektif olarak değerlendirildi. Çalışmaya dahil edilen 31 olgunun 17’si (%55) erkek, 14’ü (%45) kız idi. Yaş ortalaması 102 (2-204) ay idi. En sık başvuru semptomları sırasıyla ateş, döküntü, konjunktivit ve karın ağrısıydı. En sık kardiyolojik bulgular ise; sol ventrikül disfonksiyonu, myokardit ve koroner dilatasyondu. Ağır kardiyolojik bulguları olan 8 olgunun 4'üne kardiyak MRG yapıldı, patolojik bulgu saptanmadı. Hipotansiyon ve şok bulguları olan, laboratuvar tetkiklerinde ferritin, D-dimer, IL-6 yüksekliği olan, ekokardiyografide sol ventrikül disfonksiyonu ve myokardit bulguları olan hastaların, yoğun bakım yatış oranları daha yüksekti. Kardiyovasküler tutulumun derecesi hastalığın takibinde ve tedavi rejiminin belirlenmesinde önemlidir. Olası kalıcı kardiyak hasar açısından tüm hastalar ekokardiyografi ve kardiyak MRG ile izlenmelidir. MIS-C ciddi, yaşamı tehdit eden kardiyak belirtilere yol açabilse de, erken tanı ve uygun tedavi gelecekte ciddi kardiyak morbidite ve mortalite riskini önleyebilir.

Keywords

MIS-C, pediatrik, ekokardiyografi, MR

Evaluation of Multisystem Inflammatory Syndrome in Children (MIS-C) Cases: Clinical Features and Cardiologic Findings

Abstract

 Multisystem inflammatory syndrome in children (MIS-C) is a disease characterized by hyperinflammation with multiple organ involvement that develops after COVID-19 infection. In this study, we aimed to assess the clinical characteristics, cardiologic findings, and cardiac magnetic resonance imaging (MRI) results of MIS-C cases. Thirty-one patients diagnosed with MIS-C and followed up at Eskişehir Osmangazi University Faculty of Medicine between November 2020 and June 2022 were included in the study. The clinical and epidemiological characteristics and cardiological findings of the patients were evaluated retrospectively. Fifty-five percent of the thirty-one MIS-C cases were male and the mean age was 102 (2-204) months. The most common presenting symptoms were fever, rash, conjunctivitis, and abdominal pain. The most common cardiac findings were left ventricular dysfunction, myocarditis, and coronary artery dilatation. Cardiac MRI was performed in 4 of 8 patients with severe cardiac findings, and no pathologic findings were noted. Patients who had hypotension and cardiogenic shock at the time of admission, who had high ferritin, D-dimer, and IL -6 levels on laboratory tests, and who had left ventricular dysfunction and myocarditis on echocardiography had a high rate of ICU admission. The degree of cardiovascular involvement is important in following up on the disease and determining the treatment regimen. All patients should be monitored by echocardiography and cardiac MRI for possible permanent cardiac damage. Although MIS-C can lead to serious, life-threatening cardiac manifestations, early diagnosis and appropriate treatment can prevent the risk of serious cardiac morbidity and mortality in the future.

Keywords

MIS-C, cardiac involvement, cardiac MRI, echocardiography

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