چکیده مقاله
Background: Multisystem Inflammatory Syndrome in Children MIS C is a severe, post infectious hyperinflammatory complication of SARS CoV 2 International guidelines recommend intravenous immunoglobulin IVIG combined with corticosteroids as first line therapy However, IVIG is costly and often in short supply, particularly in resource limited settings This study describes the clinical findings, treatment patterns, and outcomes of MIS C patients from a large tertiary center in Iran, with a focus on evaluating outcomes for patients treated with corticosteroid monotherapy Methods: This retrospective, observational study analyzed medical records of children diagnosed with Multisystem Inflammatory Syndrome in Children MIS C at Akbar Children's Hospital, Mashhad, Iran, from 2020 to 2021 Out of 179 discharged patients, 84 met the CDC case definition for MIS C Participants received either intravenous immunoglobulin IVIG with or without corticosteroids 62 patients or corticosteroids alone 21 patients Statistical analyses included the Mann Whitney U test and Fisher's Exact Test, with significance set at p 0 05 Results: Over 21 months, 179 children were discharged with final diagnosis of MIS C Upon re examination, 84 patients 46 9% matched CDC criteria Based on the immunomodulatory therapy administered, the study population consisted of 62 patients who received IVIG with or without corticosteroids and 21 who received corticosteroids alone The cohort revealed two distinct phenotypes The IVIG group exhibited a cardiodominant presentation 87 1% cardiac involvement , while the steroid alone group was younger, had more comorbidities 38 1% vs 6 5%, p0 001 , and presented with prominent gastrointestinal, respiratory 38 1% , and neurologic 38 1% symptoms Mortality was comparable between groups 8 1% vs 9 5%, p=1 000 Strikingly, no patient in the steroid alone group had residual cardiac abnormalities at follow up versus 35 5% in the IVIG group p=0 001 The overall clinical profile showed high rates of gastrointestinal 98 8% and cardiac 75 9% involvement Conclusion: In this cohort, corticosteroid monotherapy was associated with favorable outcomes in MIS C patients without severe initial cardiac involvement The findings support the feasibility of phenotype directed, resource aware treatment strategies in settings with limited access to IVIG
نویسندگان
Fatemeh Moradi
Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Mohammad Saeed Sasan
Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Mohammad Hassan Aelami
Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Veda Vakili
Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
شیوه ارجاع
Moradi, Fatemeh and Sasan, Mohammad Saeed and Aelami, Mohammad Hassan and Vakili, Veda,1404,Corticosteroid Monotherapy for Non-Cardiac MIS-C: A Safe and Effective Strategy from an Iranian Cohort,37th International Congress on Pediatrics,Tehran
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