About Multisystem Inflammatory Syndrome in Children
Multisystem inflammatory syndrome in children (MIS-C) is a systemic inflammatory response to a recent COVID-19 infection, typically within 6 weeks of exposure.
- Independent of severity of initial illness
- Vaccination appears to be protective but not fully preventative
<21 yo without likely alternative diagnosis with:
- Fever
- Clinical severity requiring hospitalization
- Elevated CRP
- >2 of the following categories:
- Cardiac disease
- Shock
- Mucocutaneous disease:
- Rash
- Oral mucosal changes
- Conjunctivitis/conjunctival injection
- Extremity findings (erythema, edema)
- Gastrointestinal:
- Abdominal pain
- Vomiting
- Diarrhea
- Hematologic:
- Thrombocytopenia
- Lymphopenia
- SARs-CoV-2 exposure in past 60 days
- SARS-CoV-2 nucleic acid/antigen up to 60 days prior
- SARS-CoV-2 antibody associated with current illness (vaccine? exposure?)
- Close contact with a confirmed/probable COVID-19 case in the 60 days prior to hospitalization
- CBC, CMP, CRP, ESR
- Consider:
- Troponin, BNP, EKG
- Discussion with infectious disease or pediatric rheumatology to help guide evaluation
- Infection (bacterial/viral/tick borne)
- Toxic shock syndrome
- Staph scalded skin syndrome
- Kawasaki disease
- Myocarditis
- Serum sickness
- Admission for evaluation and treatment of inflammation, and prevention of cardiac sequelae
- Treatment for shock if present
- Echocardiogram
- Early treatment with:
- Intravenous immunoglobulin (IVIg)
- Steroids
- Aspirin
- Consider adding steroids or TNF-inhibitor for refractory cases
- Consider use of IL-1 blockade
- Example recommended post-discharge follow-up (may vary by institution):
- PCP: 1 week
- Cardiology: 2 weeks
- Rheumatology: 2 weeks
- Infectious disease: 4 weeks
- Aspirin until discontinued by cardiology
- Steroids, tapered outpatient
- No live vaccines x11 months if IVIg was administered
- Patients with history of MIS-C may be vaccinated for COVID-19.
- Wait until recovered and 90 days after MIS-C dx