Multisystem inflammatory syndrome in children with COVID-19

Abstract

Background Multisystem inflammatory syndrome in children (MIS-C) is a dangerous pediatric complication of COVID-19. Objective The purpose of this review article is to provide a summary of the diagnosis and management of MIS-C with a focus on management in the acute care setting. Discussion MIS-C is an inflammatory syndrome which can affect nearly any organ system. The most common symptoms are fever and gastrointestinal symptoms, though neurologic and dermatologic findings are also well-described. The diagnosis includes a combination of clinical and laboratory testing. Patients with MIS-C will often have elevated inflammatory markers and may have an abnormal electrocardiogram or echocardiogram. Initial treatment involves resuscitation with careful assessment for cardiac versus vasodilatory shock using point-of-care ultrasound. Treatment should include intravenous immunoglobulin, anticoagulation, and consideration of corticosteroids. Interleukin-1 and/or interleukin-6 blockade may be considered for refractory cases. Aspirin is recommended if there is thrombocytosis or Kawasaki disease-like features on echocardiogram. Patients will generally require admission to an intensive care unit. Conclusion MIS-C is a condition associated with morbidity and mortality that is increasingly recognized as a potential complication in pediatric patients with COVID-19. It is important for emergency clinicians to know how to diagnose and treat this disorder.

MIS-C-Implications for the Pediatric Surgeon: An Algorithm for Differential Diagnostic Considerations

“…Most cases were reported four to six weeks after the peak of SARS-CoV-2 infections in the affected population [8,9]. The described multisystem inflammation shows symptoms occurring as a result of a cytokine storm affecting different organs, predominantly the gastrointestinal tract, heart, hematological system as well as skin and mucosa [10,11]. In contrast to severe acute Children 2021, 8, 712 2 of 9 COVID-19, pulmonary affection is not frequently described in MIS-C [10,12].…”

Mesenteric Lymphadenitis Presenting as Acute Abdomen in a Child with Multisystem Inflammatory Syndrome

“…These GI symptoms can mimic many other infections and inflammatory diseases in children, including acute abdomen, as in our case. Apart from fever and GI symptoms, other typical symptoms of MIS-C include skin rash, conjunctivitis, lymphadenopathy, mucosal changes, oedema, coronary artery dilatation or aneurysms, myocarditis, pneumonia, and neurologic symptoms of variable severity as well as raised inflammatory markers, lymphopenia, and thrombocytopenia [ 4 , 6 , 10 , 11 ].…”

“…However, an increasing number of reports have highlighted a rare complication following COVID-19 in children, sharing similar characteristics with Kawasaki disease, the multisystem inflammatory syndrome in children (MIS-C) [ 3 , 4 ]. MIS-C is a hyperinflammatory state, defined as a constellation of the following criteria; age less than 21 years old, fever > 38 °C for over 24 h, severe illness requiring hospitalization with dysfunction of at least two organ systems, laboratory evidence of inflammation, laboratory or epidemiologic evidence of current or recent infection or exposure to SARS-CoV-2, and no alternative plausible diagnosis [ 4 , 5 , 6 ].…”

COVID-19 in children with congenital heart disease in Asia: clinical features and recommendations for management

“…17 MIS-c is a severe complication associated with COVID-19 in children. 18 Studies report MIS-c in 28% of Asian children infected with COVID-19. MIS-c associated cardiac complications include depressed ventricular function and arrythmias.…”