{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T21:46:05Z","timestamp":1789595165359,"version":"build-2803163510"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Multisystem inflammatory syndrome in children (MIS-C) is a rare, severe complication of coronavirus disease 2019, commonly involving the gastrointestinal tract. Some children with MIS-C undergo appendectomy before the final diagnosis. There are several hypotheses explaining the pathomechanism of MIS-C, including the central role of the viral antigen persistence in the gut, associated with lymphocyte exhaustion. We aimed to examine appendectomy specimens from MIS-C patients and assess their pathologic features, as well as the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigens.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>In this cross-sectional study we included 21 children with MIS-C who underwent appendectomy. The control group included 21 sex- and age-matched children with acute appendicitis (AA) unrelated to SARS-CoV-2 infection. Histologic evaluation of appendiceal specimens included hematoxylin and eosin staining and immunohistochemical identification of lymphocyte subpopulations, programmed cell death protein-1 (PD-1) and SARS-CoV-2 nucleocapsid antigen.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Appendices of MIS-C patients lacked neutrophilic infiltrate of muscularis propria typical for AA (14% vs. 95%, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001). The proportion of CD20<jats:sup>+<\/jats:sup> to CD5<jats:sup>+<\/jats:sup> cells was higher in patients with MIS-C (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.04), as was the proportion of CD4<jats:sup>+<\/jats:sup> to CD8<jats:sup>+<\/jats:sup> (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001). We found no proof of SARS-CoV-2 antigen presence, nor lymphocyte exhaustion, in the appendices of MIS-C patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The appendiceal muscularis of patients with MIS-C lack edema and neutrophilic infiltration typical for AA. SARS-CoV-2 antigens and PD-1 are absent in the appendices of children with MIS-C. These findings argue against the central role of SARS-CoV-2 persistence in the gut and lymphocyte exhaustion as the major triggers of MIS-C.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/inf.0000000000004264","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T20:00:45Z","timestamp":1715889645000},"page":"525-531","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Pathologic Analysis of Twenty-one Appendices From Children With Multisystem Inflammatory Syndrome Compared to Specimens of Acute Appendicitis: A Cross-sectional Study"],"prefix":"10.1097","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1668-6302","authenticated-orcid":false,"given":"Magdalena","family":"Okarska-Napiera\u0142a","sequence":"first","affiliation":[{"name":"From the Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9069-0695","authenticated-orcid":false,"given":"Weronika","family":"Wo\u017aniak","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7086-5841","authenticated-orcid":false,"given":"Joanna","family":"Ma\u0144dziuk","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4128-3401","authenticated-orcid":false,"given":"Kamila Maria","family":"Ludwikowska","sequence":"additional","affiliation":[{"name":"Department of Pediatric Infectious Diseases, Wroclaw Medical University, Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6613-2012","authenticated-orcid":false,"given":"Wojciech","family":"Feleszko","sequence":"additional","affiliation":[{"name":"Department of Pediatric Pneumology and Allergy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5549-2266","authenticated-orcid":false,"given":"Jakub","family":"Grzybowski","sequence":"additional","affiliation":[{"name":"Department of Pathology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1830-2114","authenticated-orcid":false,"given":"Mariusz","family":"Panczyk","sequence":"additional","affiliation":[{"name":"Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4405-8795","authenticated-orcid":false,"given":"El\u017cbieta","family":"Berdej-Szczot","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Paediatric Endocrinology, Upper-Silesian Paediatric Health Center School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1782-6701","authenticated-orcid":false,"given":"Janusz","family":"Zarycza\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Clinical Hospital in Opole, Opole, Poland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5490-7853","authenticated-orcid":false,"given":"Barbara","family":"G\u00f3rnicka","sequence":"additional","affiliation":[{"name":"Department of 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