Acute hepatitis in kids. We urge colleagues with access to samples (blood/liver tissue) to consider SARS-CoV-2 superantigen-mediated disease, potentiated by a second virus (AdV) 🧵1/ thelancet.com/journals/langa…
2/ @ArditiMd and colleagues first described a superantigen motif in SARS-CoV-2 and several groups have independently found T-cell skewing (TRBV11-2 expanded) in kids w #MISC, indicative of a superantigen-mediated inflammation. 
3/ Multiple reports have reported intestinal SARS-CoV-2 persistence and leakage of superantigens into the bloodstream trigger immune activation and possibly MIS-C in susceptible individuals, @LaelYonker et al
4/ A recent energy allocation theory could explain mild COVID-19, viral persistence and MIS-C specifically in growing children and young people: cell.com/action/showPdf…
5/ Adenoviruses (AdV) sensitises mice to superantigen (Staph. SEB) mediated disease. AdV + SEB triggered acute hepatitis in mice, while AdV or SEB alone did not cause hepatitis: journals.asm.org/doi/full/10.11…
6/ We should urgently investigate SARS-CoV-2 superantigen mediated disease, potentiated by an intestinal virus (AdV or other) as a possible mechanism of hepatitis. If confirmed, immunomodulatory treatments could be given and hopefully help.
link to commentary paper: thelancet.com/journals/langa…
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