Multisystem inflammatory syndrome in children

• Published in: Current opinion in pediatrics Vol. 33; no. 1; pp. 152 - 158
• Main Authors: Soma, Vijaya L., Shust, Gail F., Ratner, Adam J.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-02-2021
• Subjects: Child; COVID-19; Fever; Humans; Mucocutaneous Lymph Node Syndrome - diagnosis; Mucocutaneous Lymph Node Syndrome - therapy; SARS-CoV-2
• ISSN: 1040-8703; 1531-698X
• DOI: 10.1097/MOP.0000000000000974

Here we summarize current knowledge about multisystem inflammatory syndrome in children (MIS-C), a presumed postinfectious inflammatory condition that has emerged as an important COVID-19-associated complication, to help clinicians identify and manage cases.
Clinical presentation of MIS-C is dominated by significant inflammation. Fever, gastrointestinal symptoms, cardiac dysfunction, and hypotension are common features. Kawasaki disease-like findings are common, but epidemiologic data and recent mechanistic studies suggest that distinct inflammatory pathways mediate Kawasaki disease and MIS-C. A broad diagnostic approach is recommended, given overlapping presentations between MIS-C and many other disease processes. Current management of MIS-C is highly variable, depending on illness severity, and can range from supportive care to aggressive immune modulation. A multidisciplinary approach with early involvement of multiple pediatric subspecialists is recommended for complicated cases.
Several studies have described the clinical manifestations of MIS-C, but definitive diagnosis remains challenging. Robust information about long-term outcomes awaits further study, as do immunologic data to refine diagnostic and therapeutic strategies.