Multisystem Inflammatory Syndrome in Children, MIS-C

COVID-19, MIS-C

Clinical Setting

  • COVID-19 complication identified in children and adolescents under age 21 years.
  • Multisystem Inflammatory Syndrome in Children (MIS-C) (CDC HAN No, 432, 05/14/20). Also called Pediatric Multisystem Inflammatory Syndrome (PMIS)
    • Case definition:
      • Age <21 years, fever, lab evidence of inflammation, hospitalized severe illness, multi-organ involvement: cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological + no alternate diagnosis + current / recent positive test for SARS CoV-2 or COVID-19 exposure within 4 weeks of symptom onset.
    • Most common symptoms:
      • Shock, with cardiac involvement, gastrointestinal symptoms, and significantly elevated markers of inflammation and positive serology for SARS CoV-2. Similar to Kawasaki disease and toxic shock syndrome and can be difficult to distinguish. MMWR 7 Aug 2020 early release.
      • Fever, abdominal pain, rash, shock.
      • Other symptoms include conjuctivitis, headache, cervical adenopathy, lip swelling
    • Most (60-80%) SARS-CoV-2 Ab positive, some (15-30%) PCR positive
    • Lab abnormaliites:
      • lymphopenia, elevated ferritin, d-dimer, CRP, ESR, soluble IL-2 receptor, transaminases
    • Many have cardiac involvement with elevated troponin, BNP, decreased function.  Coronary artery dilation in a minority
    • Clinical phenotype likely broader including shock syndrome with cardiac involvement, Kawasaki like picture, and persistent fever with inflammation
    • Lancet. 2020 Jun 6 2020; JAMA June 8 2020

Etiologies

  • SARS CoV-2

Primary Regimens

  • No definitive data
  • IVIG 2 gm/kg
  • Methylprednisolone
  • Refractory cases: Consider anakinra or infliximab

Alternative Regimens

  • None

Comments

  • None