Be Aware: GI Complaints Are Common in Multisystem Inflammatory Syndrome in Children

When COVID-19 first came to widespread attention, it appeared that the virus was not high-risk for children compared with (especially older) adults. While that may be true in the strictest sense, as more cases have come to light and been the subject of scrutiny it’s become clear that the associated novel multisystem inflammatory syndrome in children (MIS-C) can have a severe impact on children. Now the journal Gastroenterology has published data revealing that gastrointestinal signs and symptoms are a major presentation component of MIS-C related to COVID-19. While, generally, MIS-C is characterized by systemic hyperinflammation with fever and multisystem organ dysfunction, it’s becoming clear that GI symptoms are associated with its presentation—potentially causing confusion over the diagnosis of MIS-C with other common, less toxic GI infections and inflammatory bowel disease. The Gastroenterology article takes into account a retrospective chart review of 44 children, median age 7.3 years, who were hospitalized with MIS-C between April 18, and May 22, 2020; 84.1% presented with at least one GI symptom, including abdominal pain (75%), vomiting (56.8%), diarrhea (40.1%), nausea (18.2%), and constipation (11.4%). All patients had either documented severe acute SARS-CoV-2 exposure with related symptoms; a positive SARS-CoV-2 nasopharyngeal swab (34.1%); or positive antibodies against SARS-CoV-2 spike trimer or nucleocapsid protein (96.9%). Findings of abdominal imaging studies performed in 15 patients included mesenteric adenitis (in two subjects), biliary sludge or acalculous cholecystitis (six subjects), ascites (six subjects), and bowel wall thickening (three subjects). The results could be received as encouragement for urgent care providers to probe for exposure to COVID-19 in children who present with any of the GI complaints studied.