{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:49:13Z","timestamp":1788961753303,"version":"build-2803163510"},"reference-count":88,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2020,10,14]],"date-time":"2020-10-14T00:00:00Z","timestamp":1602633600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the pathogen responsible for Coronavirus Disease 2019 (COVID-19). Whilst most children and young people develop mild symptoms, recent reports suggest a novel paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Case definition and classification are preliminary, treatment is empiric and disease-associated outcomes are unclear. Here, we report 29 patients with PIMS-TS who were diagnosed, admitted and treated in the English North West between March and June 2020. Consistent with patterns observed internationally, cases peaked approximately 4 weeks after the initial surge of COVID-19-like symptoms in the UK population. Clinical symptoms included fever (100%), skin rashes (72%), cardiovascular involvement (86%), conjunctivitis (62%) and respiratory involvement (21%). Some patients had clinical features partially resembling Kawasaki disease (KD), toxic shock syndrome and cytokine storm syndrome. Male gender (69%), black, Asian and other minority ethnicities (BAME, 59%) were over-represented. Immune modulating treatment was used in all, including intravenous immunoglobulin (IVIG), corticosteroids and cytokine blockers. Notably, 32% of patients treated with IVIG alone went into remission. The rest required additional treatment, usually corticosteroids, with the exception of two patients who were treated with TNF inhibition and IL-1 blockade, respectively. Another patient received IL-1 inhibition as primary therapy, with associated rapid and sustained remission. Randomized and prospective studies are needed to investigate efficacy and safety of treatment, especially as resources of IVIG may be depleted secondary to high demand during future waves of COVID-19.<\/jats:p>","DOI":"10.3390\/jcm9103293","type":"journal-article","created":{"date-parts":[[2020,10,17]],"date-time":"2020-10-17T05:45:51Z","timestamp":1602913551000},"page":"3293","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Presentation, Treatment Response and Short-Term Outcomes in Paediatric Multisystem Inflammatory Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS)"],"prefix":"10.3390","volume":"9","author":[{"given":"Susanna","family":"Felsenstein","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Immunology, Alder Hey Children\u2019s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Willis","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Royal Manchester Children\u2019s Hospital, Manchester M13 9WL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Lythgoe","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Alder Hey Children\u2019s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liza","family":"McCann","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Alder Hey Children\u2019s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Cleary","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Alder Hey Children\u2019s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamran","family":"Mahmood","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Alder Hey Children\u2019s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Porter","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Immunology, Alder Hey Children\u2019s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Alder Hey Children\u2019s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4555-7270","authenticated-orcid":false,"given":"Janet","family":"McDonagh","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Royal Manchester Children\u2019s Hospital, Manchester M13 9WL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Chieng","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Royal Manchester Children\u2019s Hospital, Manchester M13 9WL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Varnier","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Royal Manchester Children\u2019s Hospital, Manchester M13 9WL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Royal Manchester Children\u2019s Hospital, Manchester M13 9WL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Boullier","sequence":"additional","affiliation":[{"name":"Department of General Paediatrics, Alder Hey Children\u2019s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of General Paediatrics, Alder Hey Children\u2019s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olumoyin","family":"Awogbemi","sequence":"additional","affiliation":[{"name":"Department of General Paediatrics, Alder Hey Children\u2019s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giridhar","family":"Soda","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Manchester Children\u2019s Hospital, Manchester M13 9WL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phuoc","family":"Duong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Alder Hey Children\u2019s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Pain","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Alder Hey Children\u2019s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phil","family":"Riley","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Royal Manchester Children\u2019s Hospital, Manchester M13 9WL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1295-6179","authenticated-orcid":false,"given":"Christian M.","family":"Hedrich","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Alder Hey Children\u2019s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK"},{"name":"Department of Women\u2019s &amp; Children\u2019s Health, Institute of Translational Medicine, University of Liverpool, Liverpool L69 3BX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e440","DOI":"10.1097\/CCM.0000000000004363","article-title":"Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)","volume":"48","author":"Alhazzani","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"107233","DOI":"10.1016\/j.carpath.2020.107233","article-title":"The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities","volume":"48","author":"Buja","year":"2020","journal-title":"Cardiovasc. Pathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1038\/s41591-020-0952-y","article-title":"Disease and healthcare burden of COVID-19 in the United States","volume":"26","author":"Miller","year":"2020","journal-title":"Nat. Med."},{"key":"ref_4","unstructured":"World Health Organization (2020, August 10). Multisystem Inflammatory Syndrome in Children and Adolescents with COVID-19. Scientific Brief. 15 May 2020. WHO\/2019-nCoV\/Sci_Brief\/Multisystem_Syndrome_Children\/2020.1., Available online: https:\/\/www.who.int\/publications\/i\/item\/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1016\/S0140-6736(20)31103-X","article-title":"An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: An observational cohort study","volume":"395","author":"Verdoni","year":"2020","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1016\/S0140-6736(20)31094-1","article-title":"Hyperinflammatory shock in children during COVID-19 pandemic","volume":"395","author":"Riphagen","year":"2020","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e20201711","DOI":"10.1542\/peds.2020-1711","article-title":"SARS-CoV-2-Induced Kawasaki-Like Hyperinflammatory Syndrome: A Novel COVID Phenotype in Children","volume":"146","author":"Licciardi","year":"2020","journal-title":"Pediatrics"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Bhat, C.S., Gupta, L., Balasubramanian, S., Singh, S., and Ramanan, A.V. (2020). Hyperinflammatory Syndrome in Children Associated with COVID-19: Need for Awareness. Indian Pediatr., S097475591600208. Epub ahead of print.","DOI":"10.1007\/s13312-020-1997-1"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1056\/NEJMoa2021680","article-title":"Multisystem Inflammatory Syndrome in U.S. Children and Adolescents","volume":"383","author":"Feldstein","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1001\/jama.2020.10369","article-title":"Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2","volume":"324","author":"Whittaker","year":"2020","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1001\/jama.2020.10374","article-title":"Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City","volume":"324","author":"Cheung","year":"2020","journal-title":"JAMA"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Riollano-Cruz, M., Akkoyun, E., Briceno-Brito, E., Kowalsky, S., Posada, R., Sordillo, E.M., Tosi, M., Trachtman, R., and Paniz-Mondolfi, A. (2020). Multisystem Inflammatory Syndrome in Children (MIS-C) Related to COVID-19: A New York City Experience. J. Med. Virol.","DOI":"10.1002\/jmv.26224"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jpeds.2020.06.045","article-title":"Multisystem Inflammatory Syndrome in Children Associated with Severe Acute Respiratory Syndrome Coronavirus 2 Infection (MIS-C): A Multi-institutional Study from New York City","volume":"224","author":"Kaushik","year":"2020","journal-title":"J. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.jpeds.2020.06.044","article-title":"Characteristics, Cardiac Involvement, and Outcomes of Multisystem Inflammatory Syndrome of Childhood Associated with severe acute respiratory syndrome coronavirus 2 Infection","volume":"224","author":"Capone","year":"2020","journal-title":"J. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Lee, P.Y., Platt, C.D., Weeks, S., Grace, R.F., Maher, G., Gauthier, K., Devana, S., Vitali, S., Randolph, A.G., and McDonald, D.R. (2020). Immune dysregulation and Multisystem Inflammatory Syndrome in Children (MIS-C) in individuals with haploinsufficiency of SOCS1. J. Allergy Clin. Immunol.","DOI":"10.1016\/j.jaci.2020.07.033"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Miller, J., Cantor, A., Zachariah, P., Ahn, D., Martinez, M., and Margolis, K. (2020). Gastrointestinal symptoms as a major presentation component of a novel multisystem inflammatory syndrome in children (MIS-C) that is related to COVID-19: A single center experience of 44 cases. Gastroenterology.","DOI":"10.1053\/j.gastro.2020.05.079"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1136\/annrheumdis-2020-217960","article-title":"Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): A multicentre cohort","volume":"79","author":"Pouletty","year":"2020","journal-title":"Ann. Rheum Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1161\/CIRCULATIONAHA.120.048360","article-title":"Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic","volume":"142","author":"Belhadjer","year":"2020","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2001010","DOI":"10.2807\/1560-7917.ES.2020.25.22.2001010","article-title":"SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020","volume":"25","author":"Belot","year":"2020","journal-title":"Euro Surveill."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s13613-020-00690-8","article-title":"Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children","volume":"10","author":"Grimaud","year":"2020","journal-title":"Ann. Intensive Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"m2094","DOI":"10.1136\/bmj.m2094","article-title":"Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: Prospective observational study","volume":"369","author":"Toubiana","year":"2020","journal-title":"BMJ"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ramcharan, T., Nolan, O., Lai, C.Y., Prabhu, N., Krishnamurthy, R., Richter, A.G., Jyothish, D., Kanthimathinathan, H.K., Welch, S.B., and Hackett, S. (2020). Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. Pediatr. Cardiol.","DOI":"10.1007\/s00246-020-02391-2"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1093\/jpids\/piaa069","article-title":"Multisystem Inflammatory Syndrome in Children During the Coronavirus 2019 Pandemic: A Case Series","volume":"9","author":"Chiotos","year":"2020","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/S2352-4642(20)30215-7","article-title":"Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: A multicentre observational study","volume":"4","author":"Davies","year":"2020","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_25","unstructured":"Moraleda, C., Serna-Pascual, M., Soriano-Arandes, A., Sim\u00f3, S., Epalza, C., Santos, M., Grasa, C., Rodr\u00edguez, M., Soto, B., and Gallego, N. (2020). Multi-Inflammatory Syndrome in Children related to SARS-CoV-2 in Spain. Clin. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.15585\/mmwr.mm6932e2","article-title":"COVID-19-Associated Multisystem Inflammatory Syndrome in Children\u2014United States, March-July 2020","volume":"69","author":"Bryant","year":"2020","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"De Farias, E.C., Piva, J.P., de Mello, M.L., do Nascimento, L.M., Costa, C.C., Machado, M.M., Rodrigues, T.D., Carvalho, R.D., Alves, M.C., and Aires, L.F. Multisystem Inflammatory Syndrome Associated With Coronavirus Disease in Children: A Multi-centered Study in Belem, Para, Brazil. Pediatr. Infect. Dis. J., 2020.","DOI":"10.1097\/INF.0000000000002865"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e196","DOI":"10.1017\/S095026882000196X","article-title":"Multisystem Inflammatory Syndrome Associated with SARS-CoV-2 Infection in 45 Children: A First Report from Iran","volume":"148","author":"Mamishi","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ijid.2020.08.062","article-title":"Multisystem inflammatory syndrome in children (MIS-C): Report of the clinical and epidemiological characteristics of cases in Santiago de Chile during the SARS-CoV-2 pandemic","volume":"100","author":"Torres","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Jain, S., Sen, S., Lakshmivenkateshiah, S., Bobhate, P., Venkatesh, S., Udani, S., Shobhavat, L., Andankar, P., Karande, T., and Kulkarni, S. (2020). Multisystem Inflammatory Syndrome in Children With COVID-19 in Mumbai, India. Indian Pediatr., S097475591600230. Epub ahead of print.","DOI":"10.1007\/s13312-020-2026-0"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e2209","DOI":"10.6061\/clinics\/2020\/e2209","article-title":"Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome","volume":"75","author":"Pereira","year":"2020","journal-title":"Clinics (Sao Paulo)"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Dhanalakshmi, K., Venkataraman, A., Balasubramanian, S., Madhusudan, M., Amperayani, S., Putilibai, S., Sadasivam, K., Ramachandran, B., and Ramanan, A.V. (2020). Epidemiological and Clinical Profile of Pediatric Inflammatory Multisystem Syndrome\u2014Temporally Associated with SARS-CoV-2 (PIMS-TS) in Indian Children. Indian Pediatr., S097475591600220. Epub ahead of print.","DOI":"10.1007\/s13312-020-2025-1"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Lee, P.Y., Day-Lewis, M., Henderson, L.A., Friedman, K., Lo, J., Roberts, J.E., Lo, M.S., Platt, C.D., Chou, J., and Hoyt, K.J. (2020). Distinct clinical and immunological features of SARS-COV-2-induced multisystem inflammatory syndrome in children. J. Clin. Investig.","DOI":"10.1172\/JCI141113"},{"key":"ref_34","unstructured":"Royal College of Paediatrics and Child Health (2020, August 10). Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. Available online: https:\/\/www.rcpch.ac.uk\/resources\/guidance-paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19-pims."},{"key":"ref_35","unstructured":"Centers for Disease Control and Prevention (2020, August 10). Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19), Available online: https:\/\/emergency.cdc.gov\/han\/2020\/han00432.asp."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2302","DOI":"10.1056\/NEJMoa2006100","article-title":"Spread of SARS-CoV-2 in the Icelandic Population","volume":"382","author":"Gudbjartsson","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clinbiochem.2020.05.012","article-title":"Laboratory abnormalities in children with mild and severe coronavirus disease 2019 (COVID-19): A pooled analysis and review","volume":"81","author":"Henry","year":"2020","journal-title":"Clin. Biochem."},{"key":"ref_38","unstructured":"ECDC (2020, August 10). Paediatric Inflammatory Multisystem Syndrome and SARS-CoV-2 Infection in Children. Available online: https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/covid-19-risk-assessment-paediatric-inflammatory-multisystem-syndrome-15-May-2020.pdf."},{"key":"ref_39","first-page":"177","article-title":"COVID19: Potential cardiovascular issues in pediatric patients","volume":"91","author":"Bertoncelli","year":"2020","journal-title":"Acta Biomed."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1002\/ejhf.1828","article-title":"Myocardial localization of coronavirus in COVID-19 cardiogenic shock","volume":"22","author":"Tavazzi","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Diorio, C., Henrickson, S.E., Vella, L.A., McNerney, K.O., Chase, J.M., Burudpakdee, C., Lee, J.H., Jasen, C., Balamuth, F., and Barrett, D.M. (2020). Multisystem inflammatory syndrome in children and COVID-19 are distinct presentations of SARS-CoV-2. J. Clin. Investig.","DOI":"10.1172\/JCI140970"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Carter, M.J., Fish, M., Jennings, A., Doores, K.J., Wellman, P., Seow, J., Acors, S., Graham, C., Timms, E., and Kenny, J. (2020). Peripheral immunophenotypes in children with multisystem inflammatory syndrome associated with SARS-CoV-2 infection. Nat. Med.","DOI":"10.1038\/s41591-020-1054-6"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"108487","DOI":"10.1016\/j.clim.2020.108487","article-title":"Type 3 hypersensitivity in COVID-19 vasculitis","volume":"217","author":"Roncati","year":"2020","journal-title":"Clin. Immunol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.1056\/NEJMc2007575","article-title":"Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19","volume":"382","author":"Zhang","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e376","DOI":"10.1016\/S2665-9913(20)30137-5","article-title":"Novel paediatric presentation of COVID-19 with ARDS and cytokine storm syndrome without respiratory symptoms","volume":"2","author":"Pain","year":"2020","journal-title":"Lancet Rheumatol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/j.crad.2020.07.019","article-title":"Thromboembolic complications of COVID-19: The combined effect of a pro-coagulant pattern and an endothelial thrombo-inflammatory syndrome","volume":"75","author":"Vernuccio","year":"2020","journal-title":"Clin. Radiol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Antwi-Amoabeng, D., Kanji, Z., Ford, B., Beutler, B.D., Riddle, M.S., and Siddiqui, F. (2020). Clinical outcomes in COVID-19 patients treated with tocilizumab: An individual patient data systematic review. J. Med. Virol.","DOI":"10.1002\/jmv.26038"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"102568","DOI":"10.1016\/j.autrev.2020.102568","article-title":"Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy","volume":"19","author":"Toniati","year":"2020","journal-title":"Autoimmun. Rev."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.ijid.2020.05.026","article-title":"Use of anakinra in severe COVID-19: A case report","volume":"96","author":"Filocamo","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_50","unstructured":"University of Oxford (2020, August 10). Recovery\u2014Randomised Evaluation of COVID-19 Therapy. Available online: https:\/\/www.recoverytrial.net\/for-site-staff\/training\/children-and-neonates-1."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/j.jaci.2003.07.003","article-title":"Lymphocyte subsets in healthy children from birth through 18 years of age: The Pediatric AIDS Clinical Trials Group P1009 study","volume":"112","author":"Shearer","year":"2003","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_52","unstructured":"Advanced Life Support Group (2016). Advanced Paediatric Life Support: A Practical Approach to Emergencies (APLS), Advanced Life Support Group. [6th ed.]."},{"key":"ref_53","unstructured":"Great Ormond Street for Children NHS Trust, L., United Kingdom (2020, August 10). Haematology; Department of Laboratory Medicine, Available online: http:\/\/www.labs.gosh.nhs.uk\/media\/187007\/HRef%20range%20full%20blood%20count.pdf."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e927","DOI":"10.1161\/CIR.0000000000000484","article-title":"Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association","volume":"135","author":"McCrindle","year":"2017","journal-title":"Circulation"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1002\/art.39332","article-title":"2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: A European League Against Rheumatism\/American College of Rheumatology\/Paediatric Rheumatology International Trials Organisation Collaborative Initiative","volume":"68","author":"Ravelli","year":"2016","journal-title":"Arthritis Rheumatol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1002\/art.38690","article-title":"Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome","volume":"66","author":"Fardet","year":"2014","journal-title":"Arthritis Rheumatol."},{"key":"ref_57","unstructured":"England, P.H. (2020, August 10). Weekly Coronavirus Disease 2019 (COVID-19) Surveillance Report, Available online: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/903450\/Weekly_COVID19_Surveillance_Report_week_30_FINAL_UPDATED.pdf."},{"key":"ref_58","unstructured":"(2020, August 10). Office of National Statistics 2020, Available online: https:\/\/www.ethnicity-facts-figures.service.gov.uk\/uk-population-by-ethnicity\/national-and-regional-populations\/regional-ethnic-diversity\/latest#ethnic-groups-by-area."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Ward, H., Atchison, C.J., Whitaker, M., Ainslie, K.E., Elliot, J., Okell, L.C., Redd, R., Ashby, D., Donnelly, C.A., and Barclay, W. (2020). Antibody prevalence for SARS-CoV-2 in England following first peak of the pandemic: REACT2 study in 100,000 adults. medRxiv.","DOI":"10.1101\/2020.08.12.20173690"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/S0140-6736(20)31304-0","article-title":"Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): A population-based study","volume":"396","author":"Stringhini","year":"2020","journal-title":"Lancet"},{"key":"ref_61","unstructured":"(2020). European Centre for Disease Prevention and Control. COVID-19 in Children and the Role of School Settings in COVID-19 Transmission, 6 August 2020, ECDC."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Antunez-Montes, O.Y., Escamilla, M.I., Figueroa-Uribe, A.F., Arteaga-Menchaca, E., Lavariega-Sarachaga, M., Salcedo-Lozada, P., Melchior, P., de Oliveira, R.B., Caballero, J.C., and Redondo, H.P. (2020). COVID-19 and Multisystem Inflammatory Syndrome in Latin American children: A multinational study. medRxiv.","DOI":"10.1097\/INF.0000000000002949"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1093\/eurheartj\/ehaa311","article-title":"Cell type-specific expression of the putative SARS-CoV-2 receptor ACE2 in human hearts","volume":"41","author":"Nicin","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"198","DOI":"10.3389\/fped.2018.00198","article-title":"Kawasaki Disease","volume":"6","author":"Hedrich","year":"2018","journal-title":"Front. Pediatr."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Hameed, S., Elbaaly, H., Reid, C.E., Santos, R.M., Shivamurthy, V., Wong, J., and Jogeesvaran, K.H. (2020). Spectrum of Imaging Findings on Chest Radiographs, US, CT, and MRI Images in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19. Radiology, 202543.","DOI":"10.1148\/radiol.2020202543"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1126\/science.abc1669","article-title":"SARS-CoV-2 productively infects human gut enterocytes","volume":"369","author":"Lamers","year":"2020","journal-title":"Science"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"101604","DOI":"10.1016\/j.epsc.2020.101604","article-title":"Intestinal ischemia secondary to Covid-19","volume":"61","author":"Khesrani","year":"2020","journal-title":"J. Pediatr. Surg. Case Rep."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Lin, J., Lawson, E.C., Verma, S., Peterson, R.B., and Sidhu, R. (2020). Cytotoxic Lesion of the Corpus Callosum in an Adolescent with Multisystem Inflammatory Syndrome and SARS-CoV-2 Infection. AJNR Am. J. Neuroradiol., ahead of print.","DOI":"10.3174\/ajnr.A6755"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Abdel-Mannan, O., Eyre, M., L\u00f6bel, U., Bamford, A., Eltze, C., Hameed, B., Hemingway, C., and Hacohen, Y. (2020). Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children. JAMA Neurol.","DOI":"10.1001\/jamaneurol.2020.2687"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.3174\/ajnr.A6679","article-title":"Pressing Issues in COVID-19: Probable Cause to Seize SARS-CoV-2 for Its Preferential Involvement of Posterior Circulation Manifesting as Severe Posterior Reversible Encephalopathy Syndrome and Posterior Strokes","volume":"41","author":"Vinacci","year":"2020","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_71","unstructured":"American Academy of Pediatrics (2020, August 10). Multisystem Inflammatory Syndrome in Children (MIS-C): Interim Guidance. Available online: https:\/\/services.aap.org\/en\/pages\/2019-novel-coronavirus-covid-19-infections\/clinical-guidance\/multisystem-inflammatory-syndrome-in-children-mis-c-interim-guidance\/."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1161\/CIRCIMAGING.112.000159","article-title":"Coronary artery dimensions in febrile children without Kawasaki disease","volume":"6","author":"Muniz","year":"2013","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_73","unstructured":"National Institutes of Health (2020, August 10). Emergency awards: RADx-rad Predicting Viral-Associated Inflammatory Disease Severity in Children with Laboratory Diagnostics and Artificial Intelligence (PreVAIL kIds), Available online: https:\/\/grants.nih.gov\/grants\/guide\/rfa-files\/RFA-OD-20-023.html."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1038\/s41586-020-2538-8","article-title":"A perspective on potential antibody-dependent enhancement of SARS-CoV-2","volume":"584","author":"Arvin","year":"2020","journal-title":"Nature"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1038\/s41586-020-2008-3","article-title":"A new coronavirus associated with human respiratory disease in China","volume":"579","author":"Wu","year":"2020","journal-title":"Nature"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/S2352-4642(20)30177-2","article-title":"COVID-19 in children and adolescents in Europe: A multinational, multicentre cohort study","volume":"4","author":"Lanaspa","year":"2020","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1016\/j.chom.2020.05.008","article-title":"Type I and Type III Interferons\u2014Induction, Signaling, Evasion, and Application to Combat COVID-19","volume":"27","author":"Park","year":"2020","journal-title":"Cell Host Microbe"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1038\/s41577-020-0367-5","article-title":"Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children","volume":"20","author":"Rowley","year":"2020","journal-title":"Nat. Rev. Immunol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1038\/s41584-020-0448-7","article-title":"Autoimmune and inflammatory diseases following COVID-19","volume":"16","author":"Galeotti","year":"2020","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Consiglio, C.R., Cotugno, N., Sardh, F., Pou, C., Amodio, D., Rodriguez, L., Tan, Z., Zicari, S., Ruggiero, A., and Pascucci, G.R. (2020). The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19. Cell.","DOI":"10.1101\/2020.07.08.20148353"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1016\/j.apsb.2020.04.006","article-title":"D3Targets-2019-nCoV: A webserver for predicting drug targets and for multi-target and multi-site based virtual screening against COVID-19","volume":"10","author":"Shi","year":"2020","journal-title":"Acta Pharm. Sin. B"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1016\/j.apsb.2020.04.008","article-title":"Potential therapeutic effects of dipyridamole in the severely ill patients with COVID-19","volume":"10","author":"Liu","year":"2020","journal-title":"Acta Pharm. Sin. B"},{"key":"ref_83","first-page":"E009","article-title":"A pathological report of three COVID-19 cases by minimally invasive autopsies","volume":"49","author":"Yao","year":"2020","journal-title":"Zhonghua Bing Li Xue Za Zhi"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"421","DOI":"10.3389\/fped.2018.00421","article-title":"Childhood Vasculitis","volume":"6","author":"Schnabel","year":"2018","journal-title":"Front. Pediatr."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Gruber, C., Patel, R.S., Trachtman, R., Lepow, L., Amanat, F., Krammer, F., Wilson, K.M., Onel, K., Geanon, D., and Tuballes, K. (2020). Mapping Systemic Inflammation and Antibody Responses in Multisystem Inflammatory Syndrome in Children (MIS-C). Cell.","DOI":"10.1101\/2020.07.04.20142752"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"G1","DOI":"10.1530\/ERP-19-0050","article-title":"Normal reference intervals for cardiac dimensions and function for use in echocardiographic practice: A guideline from the British Society of Echocardiography","volume":"7","author":"Harkness","year":"2020","journal-title":"Echo Res. Pract."},{"key":"ref_87","unstructured":"Novack, M.L., and Zevitz, M.E. (2020). Natriuretic Peptide B Type (BNP) Test. StatPearls, StatPearls Publishing."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Blondiaux, E., Parisot, P., Redheuil, A., Tzaroukian, L., Levy, Y., Sileo, C., Schnuriger, A., Lorrot, M., Guedj, R., and Ducou le Pointe, H. (2020). Cardiac MRI of Children with Multisystem Inflammatory Syndrome (MIS-C) Associated with COVID-19: Case Series. Radiology, 202288.","DOI":"10.1148\/radiol.2020202288"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/10\/3293\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:21:00Z","timestamp":1760178060000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/10\/3293"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,14]]},"references-count":88,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,10]]}},"alternative-id":["jcm9103293"],"URL":"https:\/\/doi.org\/10.3390\/jcm9103293","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,14]]}}}