Multisystem Inflammatory Syndrome Mortality Following COVID-19 in Iranian Children: A Case Series and Literature Review

Background: Children generally are less contaminated by COVID-19 than other age groups, but multisystem inflammatory syndrome-children (MIS-C) can cause severe outcomes in some children. The information about MIS-C patient mortality is limited, and the cause of mortality may vary by geographical region. Therefore, we performed this case series study to report the clinical features and treatment of MIS-C patients associated with COVID-19 who died in selected referral hospitals in Iran. Case Presentation: We presented 9 cases of deceased MIS-C patients hospitalized from March 2020 to September 2021. The median age of deceased patients was 89 months (interquartile range: 8-162 mo). Five patients (55%) were male. The COVID-19 reverse transcription polymerase chain reaction (PCR) or serology test was positive in 7 children (77%). About 80% of the patients had comorbidities, most commonly obesity. All the patients were febrile at admission, and 77.78% had a fever for over 5 days. Respiratory, cardiac, and gastrointestinal signs were the most common. On admission, 6 patients were transferred to the pediatric intensive care unit. All patients received intravenous immunoglobulin and steroids.  Conclusions: The most common organ failure was lung, heart, liver, and kidney, but the main cause of death was cardiopulmonary failure. Early diagnosis and management of MIS-C are necessary to prevent severe complications and death.