Síndrome inflamatória multissistêmica (SIMS) pós-COVID-19

Um conceito em evolução

Autores

DOI:

https://doi.org/10.15448/1980-6108.2022.1.42436

Palavras-chave:

síndrome inflamatória multissistêmica, doença de Kawasaki, SARS-CoV-2, COVID-19

Resumo

INTRODUÇÃO: A potencial associação da COVID-19 com fenômenos inflamatórios e autoimunes abre um novo capítulo na prática clínica. Entre várias condições inflamatórias descritas no pós-COVID-19, destacam-se a doença de Kawasaki e uma nova afecção denominada síndrome inflamatória multissistêmica.
OBJETIVOS: Revisar, de forma prática e concisa, conceito e critérios diagnósticos da síndrome inflamatória multisistêmica, as sobreposições com a doença de Kawasaki, assim como a imunopatogênese e o tratamento desta nova e intrigante enfermidade.
MÉTODOS: Revisão da literatura disponível na base de dados Pubmed, com ênfase em revisões sistemáticas com metaanálises.
RESULTADOS: A síndrome inflamatória multisistêmica se configura como uma condição hiperinflamatória multiorgânica pós-viral. A condição é primordialmente pediátrica, e os primeiros casos foram descritos na Inglaterra em maio de 2020. Os critérios diagnósticos são ainda imprecisos, e incluem algumas manifestações doença de Kawasaki-símiles. A síndrome inflamatória multisistêmica difere da doença de Kawasaki, entretanto, por geralmente acometer crianças acima cinco anos e de raças negras ou hispânicas; em termos clínicos, se distingue pela alta frequência de gastroenteropatia, miocardiopatia e choque. O diagnóstico diferencial inclui sepse bacteriana, síndrome de ativação macrofágica e formas sistêmicas de artrite reumatoide. Uma hiperexpressão de interferons e de outras citocinas inflamatórias caracteriza patogenicamente a síndrome inflamatória mulsistêmica. A enfermidade é, via de regra, responsiva a cuidados de terapia intensiva, corticóides, imunoglobulina intravenosa e imunobiológicos.
CONCLUSÕES: A síndrome inflamatória multisistêmica é uma nova e complexa afecção hiperinflamatória associada à exposição prévia ao SARS-CoV-2. Apresenta instigantes interfaces com a doença de Kawasaki. Apesar da descrição recente, a literatura já é quantitativamente robusta, e algumas pendências de imunopatogênese, critérios diagnósticos e terapêutica deverão ser esclarecidas em breve.

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Biografia do Autor

Henrique Luiz Staub, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Porto Alegre, RS, Brasil.

Médico Reumatologista, Doutor em Clínica Médica/Reumatologia, Professor Adjunto de Reumatologia e Imunologia Clínica da Escola de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brasil.

Lia Portella Staub, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Porto Alegre, RS, Brasil.

Estudante de Medicina, Escola de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brasil.

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Publicado

2022-01-25

Como Citar

Staub, H. L., & Staub, L. P. (2022). Síndrome inflamatória multissistêmica (SIMS) pós-COVID-19: Um conceito em evolução. Scientia Medica, 32(1), e42436. https://doi.org/10.15448/1980-6108.2022.1.42436

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