MIS-C related to SARS-CoV-2 infection: a narrative review of presentation, differential diagnosis, and management

Abstract

Multisystem Inflammatory Syndrome in Children (MIS-C), a rare condition, has been reported approximately 2-4 weeks after the onset of COVID-19 in children and adolescents, causing inflammation in multiple systems, including cardiovascular and respiratory, digestive, and central nervous systems. This condition is also known as hyperinflammatory shock, Kawasaki-like disease, and Pediatric Inflammatory Multisystem Syndrome (PIMS). The signs and symptoms include but are not limited to fever, rash, peripheral edema, gastrointestinal symptoms, conjunctivitis, and shock. Thirty-eight studies met our criteria, with a total of 5822 patients. The most affected population was between 5-18 years of age. We noted that MIS-C presented with a wide range of signs and symptoms that overlap with Kawasaki Disease, including high fever, sore throat, malaise, tachypnea, tachycardia, conjunctival injection, mucosal edema, cardiac involvement, and gastrointestinal symptoms. It causes an increase SUMMARY in IL-17A, IL-6, and arterial damage, a distinct difference from Kawasaki disease. The laboratory findings in MIS-C showed an increase in inflammatory markers like CRP, ESR, ferritin, leukocytes, and TNF-α. WHO stated that 23% of affected children with MIS-C had underlying conditions like chronic lung diseases, cardiovascular disease, and immunosuppression. In most affected children, aspirin and IVIG were successful, which resulted in a decrease in the inflammatory markers. We find that MIS-C is a rare, but potentially fatal pediatric complication, after COVID-19 infection. The aim of this article is to study the emerging relationship between COVID-19 and MIS-C in children and adolescents affected by this condition, to discuss the immunological mechanisms, and explore potential therapies.

Clinical and Laboratory Features of Patients with Multisystem Inflammatory Syndrome in Children (MIS-C): An Experience From Queen Rania Children’s Hospital, Jordan

“…The majority of our patients showed elevated inflammatory markers, including CRP (greater than 5 mg/dL in 98.7%), ESR (greater than 20 mm/hr in 92.5%), and ferritin levels (greater than 400 μg/L in 70%), consistent with immune dysregulation-induced cytokine storm and consistent with those found in the literature [3,21]. Lymphopenia in our study was reported in 72.5% of patients, higher than reported by Mamishi et al (54%) and (64%) by Lee et al [19,22]. Lymphopenia was statistically evident in patients younger than five years old (p-value = 0.001), contrary to that reported by Feldstein et al [9], where lymphopenia was more pronounced in older patients.…”

If SARS-CoV-2 is blamed for causing meningoencephalitis, the virus must be detected in the CSF

“…A fifth limitation of the study is that multi-inflammatory syndrome in childhood (MIS-C) as one of the differential diagnoses in a child with COVID-19 was not entirely ruled out [3]. According to the WHO diagnostic criteria for MIS-C, the following six criteria must be met: 1) age <20y, 2) fever >2 days, 3) clinical signs of multisystem involvement, 4) elevated inflammatory markers, 5) no other obvious microbial cause of inflammation, and 6) confirmed SARS-CoV-2 infection [4].…”