Clinical features, diagnosis, and outcomes of multisystem inflammatory syndrome in children associated with coronavirus disease 2019

Abstract

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been spreading worldwide since December 2019. Hundreds of cases of children and adolescents with Kawasaki disease (KD)-like hyperinflammatory illness have been reported in Europe and the United States during the peak of the COVID-19 pandemic with or without shock and cardiac dysfunction. These patients tested positive for the polymerase chain reaction or antibody test for SARS-CoV-2 or had a history of recent exposure to COVID-19. Clinicians managing such patients coined new terms for this new illness, such as COVID-19-associated hyperinflammatory response syndrome, pediatric inflammatory multisystem syndrome temporally associated with COVID-19, or COVID-19-associated multisystem inflammatory syndrome in children (MIS-C). The pathogenesis of MIS-C is unclear; however, it appears similar to that of cytokine storm syndrome. MIS-C shows clinical features similar to KD, but differences between them exist with respect to age, sex, and racial distributions and proportions of patients with shock or cardiac dysfunction. Recommended treatments for MIS-C include intravenous immunoglobulin, corticosteroids, and inotropic or vasopressor support. For refractory patients, monoclonal antibody to interleukin-6 receptor (tocilizumab), interleukin-1 receptor antagonist (anakinra), or monoclonal antibody to tumor necrosis factor (infliximab) may be recommended. Patients with coronary aneurysms require aspirin or anticoagulant therapy. The prognosis of MIS-C seemed favorable without sequelae in most patients despite a reported mortality rate of approximately 1.5%.

Keywords: COVID-19; Kawasaki disease; Multisystem inflammatory syndrome in children; SARS-CoV-2.

Fig. 1.

Pathogenesis of multisystem inflammatory syndrome in children [5,25] KD, Kawasaki disease; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Fig. 2.

Clinical features of multisystem inflammatory syndrome in children [15,35-37] SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; PCR, polymerase chain reaction; Pro-BNP, pro-B type natriuretic peptide; KD, Kawasaki disease; LV, left ventricular; GI, gastrointestinal.

Fig. 3.

Clinical outcomes of multisystem inflammatory syndrome in children [15,35-37]. MV, mechanical ventilation; ECMO, extracorporeal membrane oxygenation.