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소아 다기관 염증 증후군

Multisystem Inflammatory Syndrome in Children (MIS-C)

Lee Hyunju|Cho Eun Young|Lee Joon Kee
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)|2021.08|Pediatric Infection and Vaccine|제28권 제2호|pp. 66-81|DOI 10.14776/piv.2021.28.e13

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COVID-19ChildSARS-CoV-2TherapeuticsPediatric multisystem inflammatory diseaseCOVID-19 related

초록

코로나바이러스감염증-19는 전 세계적으로 유행하고 있으며, 2021년 7월 15일 기준으로 1.88억명 이상의 확진자와 406만 명 이상의 사망자가 발생하였다. 소아청소년에서는 성인에 비해 비교적 중증 감염 발생이 낮으나, 일부에서는 SARS-CoV-2 감염 약 2–6주 후 소아다기관염증증후군(multisystem inflammatory syndrome in children, MIS-C)라는 합병증이 발생할 수 있다. MIS-C는 어린 영아부터 청소년까지 다양한 연령에서 발생할 수 있으며, 발열을 포함하여 다양한 장기와 관련된 증상을 보일 수 있다. 소화기 및 신경계 증상이 흔하며, 많은 경우 가와사키병과 유사한 피부점막증상 등이 나타난다. 특히 심장관련 증상으로 좌심실 기능저하, 심근염 등이 나타날 수 있으며, 관상동맥확장 및 관상동맥류가 나타날 수 있다. 경우에 따라 저혈압, 쇼크를 동반하며, 중환자실 치료 및 기계환기요법을 요하나, 적절한 치료 후 대체로 회복을 보이는 것으로 보고된다. 이와 같이 MIS-C는 소아청소년에서 SARS-CoV-2 이후 드물게 발생하는 중요한 합병증으로, 임상증상을 잘 인지하고 조기에 적절한 치료를 하는 것이 중요하다. 이에 본 종설에서는 MIS-C의 역학 및 임상 증상, 추정되는 병태생리, 진단적 접근 및 치료에 대해 다루고자 한다.

Abstract

The coronavirus disease 2019 pandemic has been continuously spreading throughout the world. As of July 15, 2021, there have been more than 188 million confirmed cases and more than 4.06 million deaths. Although the incidence of severe infections is relatively low in children and adolescents compared to adults, a complication called multisystem inflammatory syndrome in children (MIS-C) may occur in some cases at approximately 2–6 weeks after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. MIS-C can be seen in patients of various ages, from young infants to adolescents, and may present with diverse clinical manifestations. While fever present in a great majority of patients, symptoms suggesting the involvement of the digestive or nervous system and the skin and mucous membranes (Kawasaki disease-like symptoms) also appear in many cases. Cardiac involvement may also be observed, including left ventricular dysfunction, myocarditis, coronary artery dilatation, and coronary aneurysm. In some cases, hypotension or shock can occur, and mechanical ventilation or treatment in the intensive care unit may be necessary. Fortunately, recovery is generally reported after appropriate treatment. MIS-C is a rare but important complication of SARS-CoV-2 infection in children and adolescents. As such, it is important to recognize the clinical symptoms and provide appropriate treatment at an early stage. In this review, the epidemiology, clinical symptoms, suggested pathophysiology, diagnostic approach, and treatment of MIS-C will be discussed.

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관련 논문AI추천

조절되지 않는 열, 구토, 발진으로 발현한 코로나바이러스병-19 연관 소아 다기관염증증후군 1례고찬영대한소아응급의학회 · 대한소아응급의학회지2023 · 제10권 제4호소아청소년 코로나바이러스감염증-19: 역학과 임상 양상강지만, 김동현, 김한울, 조은영, 최수한대한소아감염학회 · Pediatric Infection and Vaccine2020 · 제27권 제1호A Case of Multisystem Inflammatory Syndrome in Children (MIS-C) with Acute MyocarditisChoi Sujin, Lee Da Hye, Lee Hyunju, Lee Joowon, Lim Jin Gyu, Oh Kyung Jin, Song Young Hwan대한소아감염학회 · Pediatric Infection and Vaccine2021 · 제28권 제3호A Case of 1-Month Fever Caused by CMV Infection in a Patient With MIS-C Treated With IVIG, Infliximab, and High-Dose MethylprednisoloneJeong Gihun, You Jihye대한소아감염학회 · Pediatric Infection and Vaccine2024 · 제31권 제1호가와사키병 진단의 최신 지견한지환대한소아응급의학회 · 대한소아응급의학회지2018 · 제5권 제1호Severe SARS-CoV-2 Infection With Multiorgan Involvement Followed by MIS-C in an AdolescentHan Mi Seon, Lim Bomi, Shin Su-Mi대한소아감염학회 · Pediatric Infection and Vaccine2022 · 제29권 제3호

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