Manifestaciones Extra pulmonares de la infección por SARS-CoV-2 en Pediatría. Revisión
DOI:
https://doi.org/10.18004/anales/2020.053.02.87Palabras clave:
SARS-Cov-2, Covid-19, Síndrome Inflamatorio Multisistémico pediátrico, Enfermedad de Kawasaki, manifestaciones dermatológicas, manifestaciones gastrointestinales, manifestaciones neurológicas, ParaguayResumen
Las manifestaciones clínicas del SARS-Cov-2 en niños difieren a la de los adultos, con afección respiratoria, gastrointestinal, dermatológica y/o cardiovascular. La mayoría de los niños son asintomáticos o presentan síntomas leves de la infección por COVID-19. Sin embargo, en los últimos meses se ha identificado un pequeño número de niños que desarrollan respuesta inflamatoria sistémica significativa. A continuación, realizamos una revisión sobre las manifestaciones extrapulmonares del SARS-Cov-2.
Referencias
1. Organización Mundial de la Salud. Línea del tiempo. 2020. https://www.who.int/es/news-room/detail/27-04-2020-who-timeline---covid-19.
2. Jiatong S, Wenjun L. Epidemiological characteristics and prevention and control measures of Corona Virus Disease 2019 in children. J Trop Med. 2020; 20(2):153‐156.
3. Organización Mundial de la Salud. Informe de la misión conjunta OMS-China sobre la enfermedad por coronavirus 2019 (COVID-19) 16-24 de febrero de 2020. Ginebra: Organización Mundial de la Salud; 2020 Disponible en: https://www.who.int/docs/default- source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf.
4. Lu R., Zhao X., Li J., Niu P., Yang B., Wu H., et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020. 22 February; 395(10224):565-574.
5. Kramer A., Schwebke I., Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006; 6:130.
6. Wan Y., Shang J., Graham R., Baric R.S., Li F. Receptor recognition by novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS. J Virol. 2020 JVI.00127-00120.
7. Li W., Moore M.J., Vasilieva N., Sui J., Wong S.K., Berne M.A. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003; 426(6965):450-454.
8. Wu D, Wu T, Liu Q, Yang Z. The SARS‐CoV‐2 outbreak: what we know. Int J Infect Dis 2020; 94:44-48.
9. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. New Engl J Med 2020; 382(13):1199-1207.
10. Huang C , Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395:497-506.
11. Chen C, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395:809-815.
12. Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang Z-J. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA 2020. 10.1001/jama.2020.2131
13. Shen K, Yang Y, Wang T, Zhao D, Jiang Y, Jin R, et al. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts’ consensus statement. World J Pediatr. 2020; 16(3):223-231. doi:10.1007/s12519-020-00343-7
14. Paraluppi V, Pintus MC, Fanos V, Marcialis MA. COVID-19 in newborns and in children: the state of the art. J Pediatr Neonat Individual Med. 2020; 9(1):e090138. doi: 10.7363/090138.
15. Pediatric Intensive Care Society. PICS statement: Increased number of reported cases of novel presentation of multi-system inflammatory disease. April 27, 2020. Available at: https://picsociety.uk/wpcontent/uploads/2020/04/PICS-statement-re-novel-KD-C19-presentation-v2-27042020.pdf
16. Corman VM, Landt O, Kaiser M, MolenKamp R, Meijer A, Chu DKW, et al. Detection of 2019 novel coronavirus (2019‐nCoV) by real‐time RT‐PCR. Euro Surveill.2020; 25(3):2431‐2438.
17. Long QX, Liu BZ, Deng HJ, Wu GC, Deng K, Chen YK, et al. Antibody responses to SARS-CoV-2 in patients with COVID-19. Nat Med. 2020; 26(6):845-848.
18. Lou B, Li T, Zheng S, Su Y, Li Z, Liu W, et al. Serology characteristics of SARS-CoV-2 infection since the exposure and post symptoms onset. medRxiv. 2020. doi:10.1101/2020.03.23.20041707.
19. Ministerio de salud Pública y Bienestar Social. COVID-19. Definiciones de casos. Momentos para toma de muestra. Criterios de alta de aislamiento y cuarentena. MSP. Py. 28 abril 2020. https://www.mspbs.gov.py/dependencias/portal/adjunto/d09c2a-ProtocoloDefinicionesdecasos.TomadeMuestras.Alta.pdf
20. Sethuraman N, Jeremiah SS, Ryo A. Interpreting Diagnostic Tests for SARS-CoV-2. JAMA. 2020; 323(22):2249-2251. doi:10.1001/jama.2020.8259.
21. Murray KF, Gold BD, Shamir R, Agostoni C, Pierre-Alvarez R, Kolacek S, et al. Coronavirus Disease 2019 and the Pediatric Gastroenterologist. J Pediatr Gastroenterol Nutr 2020; 70(6):720-726.
22. Cai X, Ma Y, Li S, Chen Y, Rong Z, Li W. Clinical Characteristics of 5 COVID-19 Cases With Non-respiratory Symptoms as the First Manifestation in Children. Front Pediatr. 2020 May 12; 8:258.
23. Santos VS, Gurgel RQ, Cuevas LE, Martins-Filho PR. Prolonged fecal shedding of SARS-CoV-2 in pediatric patients. A quantitative evidence synthesis. J Pediatr Gastroenterol Nutr . 2020 May 22:10.1097/MPG.0000000000002798.
24. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA . 2020 Feb 7; 323(11):1061-9. doi: 10.1001/jama.2020.1585.
25. Gu J, Han B, Wang J. COVID-19: Gastrointestinal Manifestations and Potential Fecal-Oral Transmission. Gastroenterology. 2020 May; 158(6):1518-1519. doi: 10.1053/j.gastro.2020.02.054.
26. Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020; 69(6):1002-1009. doi:10./gutjnl-2020-320926
27. Luo S, Zhang X, Xu H. Don’t Overlook Digestive Symptoms in Patients With 2019 Novel Coronavirus Disease (COVID-19). Clin Gastroenterol Hepatol. 2020 Jun; 18(7):1636-1637.
28. Musa S. Hepatic and gastrointestinal involvement in coronavirus disease 2019 (COVID-19): What do we know till now?. Arab J Gastroenterol. 2020; 21(1):3-8.
29. Lee IC, Huo TI, Huang YH. Gastrointestinal and liver manifestations in patients with COVID-19. J Chin Med Assoc. 2020; 83(6):521-523.
30. Patel KP, Patel PA, Vunnam RR, Hewlett AT, Jain R, Jing R, Vunnam SR. Gastrointestinal, hepatobiliary, and pancreatic manifestations of COVID-19. J Clin Virol. 2020; 128:104386. doi:10.1016/j.jcv.2020.104386
31. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol 2020. https://doi.org/10.1111/jdv.16387
32. Zheng Y, Lai W. Dermatology staff participate in fight against Covid-19 in China. JEADV 2020, 34, e210-e240. https://doi.org/10.1111/jdv.16390
33. Lee CH. Role of dermatologists in the uprising of the novel corona virus (COVID-19): Perspectives and opportunities. Dermatol Sin. 2020; 38:1-2.
34. Galván Casas C, Català A, Carretero Hernández G, Rodríguez-Jiménez P, Fernández-Nieto D, Rodríguez-Villa Larioet A, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020; 183(1):71-77. doi:10.1111/bjd.19163
35. Chen Y, Peng H, Wang L, Zhao Y, Zeng L, Gao H, Liu Y. Infants Born to Mothers with a New Coronavirus (COVID-19). Front. Pediatr. 2020; 8:104. doi: 10.3389/fped.2020.00104
36. Morey-Olivé M, Espiau M, Mercadal-Hally M, Lera-Carballo E, García-Patos V. Cutaneous manifestations in the current pandemic of coronavirus infection disease (COVID 2019). An Pediatr (Engl Ed). 2020 Apr 27. doi: 10.1016/j.anpede.2020.04.002
37. Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for dengue. J Am Acad Dermatol. 2020; 82(5):e177. doi:10.1016/j.jaad.2020.03.036
38. Henry D, Ackerman M, Sancelme E, Finon A, Esteve E. Urticarial eruption in COVID-19 infection. J Eur Acad Dermatol Venereol . 2020; 34(6):e244-e245. doi:10.1111/jdv.16472
39. Mazzotta F., Troccoli T. Acute acro-ischemia in the child at the time of COVID-19. Eur. J. Pediat. Dermatol. 2020; 30(2):71-74. DOI: 10.26326/2281-9649.30.2.2102
40. Manalo IF, Smith MK, Cheeley J, Jacobs R. A dermatologic Manifestation of COVID-19: Transient Livedo Reticularis. J Am Acad Dermatol . 2020. Apr 10; S0190-9622(20)30558-2.
41. Esper R, Shapiro ED, Weibel C, Ferguson D, Landry ML, Kahn JS. Association Between a Novel Human Coronavirus and Kawasaki Disease. J Infect Dis 2005 Feb 15;191(4):499-502.
42. Turnier JL, Anderson MS, Heizer HR, Jone PN, Glodé MP, Dominguez SR. Concurrent Respiratory Viruses and Kawasaki Disease. Pediatrics. 2015; 136(3):e609‐e614. doi:10.1542/peds.2015-0950.
43. McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation. 2017; 135(17):e927-e999. doi:10.1161/CIR.0000000000000484
44. Pinto FF, Laranjo S, Mota Carmo M, Brito MJ, Cruz Ferreira R. Twelve Years of Kawasaki Disease in Portugal: Epidemiology in Hospitalized Children. Pediatr Infect Dis J. 2017; 36(4):364‐368. doi:10.1097/INF.0000000000001444.
45. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet . 2020; 395(10237):1607‐1608. doi:10.1016/S0140-6736(20)31094-1.
46. Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet . 2020; 395(10239):1771-1778. doi:10.1016/S0140-6736(20)31103-X
47. Pleasure SJ, Green AJ, Josephson SA. The Spectrum of Neurologic Disease in the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic Infection: Neurologists Move to the Frontlines. JAMA Neurol. 2020; 10.1001/jamaneurol.2020.1065.
48. Liu K, Pan M, Xiao Z, Xu X. Neurological manifestations of the coronavirus (SARS-CoV-2) pandemic 2019-2020. J Neurol Neurosurg Psychiatry. 2020; 91(6):669-670. doi:10.1136/jnnp-2020-323177
49. Bridwell R, Long B, Gottlieb M. Neurologic complications of COVID-19. Am J Emerg Med. 2020; 38(7):1549.e3-1549.e7. doi:10.1016/j.ajem.2020.05.024
50. Nath A. Neurologic complications of coronavirus infections. Neurology. 2020; 94(19):809-810. doi:10.1212/WNL.0000000000009455
51. Spinato G, Fabbris C, Polesel J, Cazzador D, Borsetto D, Hopkins C, Boscolo-Rizzo P. Alterations in Smell or Taste in Mildly Symptomatic Outpatients With SARS-CoV-2 Infection. JAMA . 2020; 323(20):2089-2090. doi:10.1001/jama.2020.6771
52. Gutiérrez-Ortiz C, Méndez A, Rodrigo-Rey S, San Pedro-Murillo E, Bermejo-Guerrero L, Gordo-Mañas R. Miller Fisher Syndrome and polyneuritis cranialis in COVID-19. Neurology Apr 2020, 10.1212/WNL.0000000000009619
53. Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni MG, et al. Guillain-Barré Syndrome Associated with SARS-CoV-2. N Engl J Med. 2020; 382(26):2574-2576. doi:10.1056/NEJMc2009191
54. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med . 2020; 382(20):e60. doi:10.1056/NEJMc2009787
55. Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B. COVID-19-associated Acute Hemorrhagic Necrotizing Encephalopathy: Imaging Features. Radiology. 2020; 296(2):E119-E120. doi:10.1148/radiol.2020201187
56. Li Y, Li M, Wang M, Zhou Y, Chang J, Xian Y, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol. 2020; svn-2020-000431. doi:10.1136/svn-2020-000431
57. Domingues RB, Mendes-Correa MC, de Moura Leite FBV, Cerdeira Sabino E, Zanotti Salarini D, Claro I, et al. First case of SARS-COV-2 sequencing in cerebrospinal fluid of a patient with suspected demyelinating disease. J Neurol. 2020; 1-3. doi:10.1007/s00415-020-09996-w
58. Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers D, Kant KM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thromb Res. 2020; 191:148-150. doi:10.1016/j.thromres.2020.04.041
59. Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis . 2020; 94:55-58. doi:10.1016/j.ijid.2020.03.062
60. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020. doi:10.1136/bmj.m1091
61. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet . 2020; 395(10224):565-574. doi:10.1016/S0140-6736(20)30251-8
62. Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host-Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chem Neurosci. 2020; 11(7):995-998.
63. Fotuhi M, Mian A, Meysami S, Raji C. Neurobiology of Covid-19. Journal of Alzheimer Disease.2020; 76(1):3-19. DOI: 10.3233/JAD-200581
64. Butowt R, Bilinska K. SARS-cov-2: olfaction, brain infection, and the urgent need for clinical samples allowing earlier virus detection. ACS Chem. Neurosci. 2020; 11(9):1200-3.
65. Paderno A, Mattavelli D, Rampinelli V, Grammatica A, Raffetti E, Tomasoni M, et al. Olfactory and Gustatory Outcomes in COVID-19: A Prospective Evaluation in Nonhospitalized Subjects. Otolaryngol Head Neck Surg. 2020 Jun 30:194599820939538. doi: 10.1177/0194599820939538.
66. Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020; 87:18-22.
67. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol . 2020; 77(6):1-9. doi:10.1001/jamaneurol.2020.1127
68. Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M, Oreni L, et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study. Clin Infect Dis. 2020;ciaa330. doi:10.1093/cid/ciaa330
69. Virani A, Rabold E, Hanson T, Haag A, Elrufay R, Cheema T, et al. Guillain-Barré Syndrome associated with SARS-CoV-2 infection. IDCases. 2020; 20:e00771. doi:10.1016/j.idcr.2020.e00771
70. Alberti P, Beretta S, Piatti M, Karantzoulis A, Piatti ML, Santoro P, et al. Guillain-Barré syndrome related to COVID-19 infection. Neurol Neuroimmunol Neuroinflamm. 2020; 7(4):e741. Published 2020 Apr 29. doi:10.1212/NXI.0000000000000741
71. Padroni M, Mastrangelo V, Asioli GM, Pavolucci L, Abu-Rumeileh S, Piscaglia MG, et al. Guillain-Barré syndrome following COVID-19: new infection, old complication?. J Neurol . 2020; 267(7):1877-1879. doi:10.1007/s00415-020-09849-6
72. Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, et al. Neurologic Features in Severe SARS-CoV-2 Infection. N Engl J Med . 2020; 382(23):2268-2270. doi:10.1056/NEJMc2008597
73. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiology of COVID-19 among children in China. Pediatrics Jun 2020; 145(6) e20200702; DOI: 10.1542/peds.2020-0702.
74. Schupper AJ, Yaeger KA, Morgenstern PF. Neurological manifestations of pediatric multi-system inflammatory syndrome potentially associated with COVID-19. Childs Nerv Syst. 2020; 36(8):1579-1580. doi:10.1007/s00381-020-04755-8
75. Abdel-Mannan O, Eyre M, Löbel U, Bamford A, Eltze C, Hameed B, et al. Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children.JAMA Neurol.. 2020; e202687. doi:10.1001/jamaneurol.2020.2687
76. Grimaud M, Starck J, Levy M, Marais C, Chareyre J, Khraiche D, et al. Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children. Ann Intensive Care. 2020 Jun 1; 10(1):69. doi: 10.1186/s13613-020-00690-8. PMID: 32488505; PMCID: PMC7266128.
77. Deza Leon MP, Redzepi A, McGrath E, Abdel-Haq N, Shawaqfeh A, Sethuraman U, et al. COVID-19-Associated Pediatric Multisystem Inflammatory Syndrome. J Pediatric Infect Dis Soc. 2020; 9(3):407-408. doi:10.1093/jpids/piaa061
78. Toubiana J, Poirault C, Corsia A, Bajolle F, Fourgeaud J, Angoulvant F, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ . 2020; 369:m2094. Published 2020 Jun 3. doi:10.1136/bmj.m2094
79. Licciardi F, Pruccoli G, Denina M, Parodi E, Taglietto M, Rosati S, Montin D. SARS-CoV-2-Induced Kawasaki-Like Hyperinflammatory Syndrome: A Novel COVID Phenotype in Children. Pediatrics . 2020; e20201711. doi:10.1542/peds.2020-1711
80. Panupattanapong S., Brooks EB. New spectrum of COVID-19 manifestations in children: Kawasaki-like síndrome and hyperinflammatory response. Cleve Clin J Med; 2020 Jun 03. DOI: 10.3949/ccjm.87a.ccc039
81. Viner RM, Whittaker E. Kawasaki-like disease: emerging complication during the COVID-19 pandemic. Lancet . 2020 May 13 doi: 10.1016/S0140-6736(20)31129-6
82. Hennon TR, Penque MD, Abdul-Aziz R, Alibrahim OS, McGreevy MB, Prout AJ, et al. COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; a Western New York approach. Prog Pediatr Cardiol. 2020 May 23: 101232. doi: 10.1016/j.ppedcard.2020.101232
83. Royal College of Paediatrics and Child Health. Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. 2020. https://www.rcpch.ac.uk/resources/guidance-paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19
84. CDC. Multisystem Inflammatory Syndrome in Children (MIS-C) associated with coronavirus disease 2019 (COVID-19). 2020. https://emergency.cdc.gov/han/2020/han00432.asp
85. Kavirayani A, Adwani S, Weitz J, Segal S. Suspected Paediatric Multisystem Inflammatory Syndrome / PIMS-TS. OUH clinical guideline. Oxford University Hospitals NHS Trust, May 2020.
86. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory Shock in Children During COVID-19 Pandemic. Lancet 2020; 395(10237):1607-1608. doi: 10.1016/S0140-6736(20)31094-1. Epub 2020 May 7 .
87. Nakra NA, Blumberg DA, Herrera-Guerra A, Lakshminrusimha S. Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed Management. Children (Basel). 2020; 7(7):E69. Published 2020 Jul 1. doi:10.3390/children7070069
88. Belot A, Antona D, Renolleau S, Javouhey E, Hentgen V, Angoulvant F, et al. SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020. Euro Surveill . 2020; 25(22):2001010. doi:10.2807/1560-7917.ES.2020.25.22.2001010
89. Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med 2020; 383:334-346. DOI: 10.1056/NEJMoa2021680
90. Pouletty M, Borocco C, Ouldali N, Caseris M, Basmaci R, Lachaume N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis 2020; 79:999-1006.
91. Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, et al. American College of Rheumatology Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS‐C) Associated with SARS‐CoV‐2 and Hyperinflammation in COVID‐19. Version 1. Arthritis Rheumatol. Accepted Author Manuscript. 2020. doi:10.1002/art.41454.
