Testing for and identification of Multisystem Inflammatory Syndrome in children in the pediatric emergency department

Abstract

Purpose of review: The current article summarizes updates on multisystem inflammatory syndrome in children (MIS-C) research and focuses on strategies to diagnose and manage these patients in the emergency department.

Recent findings: MIS-C is an inflammatory syndrome that occurs approximately 4-5 weeks after severe acute respiratory syndrome coronavirus 2 infection. It is associated with symptoms such as fever, shock, abdominal pain, rash, and conjunctivitis along with laboratory abnormalities such as elevated inflammatory markers, coagulation factors, and cytokines. Patients fall into the following three subcategories: first, classic or incomplete Kawasaki; second, cardiogenic or distributive shock; or third, an inflammatory response that does not initially meet criteria of the other subcategories. Immediate treatment largely focuses on supportive care through fluid resuscitation and pressor support; however, inpatient management may also include intravenous immunoglobulin, steroids, anticoagulation and at times anti-inflammatory biologics.

Summary: Overall fatality rate remains low and short-term research has demonstrated self-limited sequelae. Pediatricians should focus on the timely diagnosis and identification of this inflammatory disease via clinical findings and laboratory evidence to best treat these patients.