What Is Multisystem Inflammatory Syndrome in Children (MIS-C)?

Published on 
June 24, 2020

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An expert explains the mysterious condition affecting some children who’ve had COVID-19.

By Melinda Smith 

From the beginning of the COVID-19 pandemic, children have been a population left relatively untouched by the novel coronavirus. If infected, children often have few symptoms unless an underlying condition compromised their health. It was believed that children could have the disease without even showing any symptoms. 

CHLA Cardiologist Jackie Szmuszkovicz, MD, specializes in Kawasaki disease, which is a rare pediatric condition characterized by inflammation of blood vessels and abnormal dilations of the arteries supplying the heart with blood. Dr. Szmuszkovicz and her colleagues noticed an increase in the number of patients diagnosed with Kawasaki disease in the month of April as compared to the previous twoyears. CHLA’s team began testing to determine whether the patients seen in recent months had antibodies demonstrating past COVID-19 infection. This began as hospitals in the United Kingdom and New York City started reporting children with significant inflammation, including problems that seemed similar to toxic shock syndrome and symptoms of Kawasaki disease, following infection with the novel coronavirus.  

Symptoms like Kawasaki Disease

It turned out that a syndrome that can appear clinically very much like Kawasaki disease was emerging. Pediatric hospitals are sharing stories of children suffering from multisystem inflammatory syndrome in children, or MIS-C (formerly referred to as pediatric inflammatory multisystem syndrome, or PIMS). Though the information available about MIS-C is still extremely limited due to the small numbers of cases compared with the staggering numbers of people affected by COVID-19, pediatric specialists around the country, including those at Children’s Hospital Los Angeles, are focusing their efforts on determining whether more cases exist, and more clearly defining this new entity. 

Dr. Szmuszkovicz explains that while MIS-C is very new, CHLA is extremely vigilant. She and her team immediately shared information. “We alerted clinicians to be looking out for children who had high fever persisting for 4 or 5 days or more, and with other symptoms, some of which might include a rash, red lips or red tongue, red eyes, swollen and/or red hands or feet, an enlarged lymph node in the neck, abdominal pain and or diarrhea without any other explanation. Because of our past experience with Kawasaki disease, we also alerted people to be watchful for any infant who had fever for 7 days without another explanation and/or any of these symptoms,” she says. 

Timely Treatment Is Key

Sharon Wagner-Lees, RN, NPD-BC, BSN, MBA, a nurse who specializes in caring for cardiac patients, is leading care teams specializing in this new disorder. “MIS-C is treatable but time is of the essence,” she explains. “A subset of patients experience vascular changes,” she says. Many of these vascular changes will subside and vessels often return to normal size following treatment, however dilated blood vessels could lead to more serious cardiac events. In some children, heart function can also be depressed. Forthis reason, when Kawasaki disease or MIS-C is suspected, a team of experts including cardiologists and infectious disease clinicians develop a detailed plan of action for each child. 

Specialists in Cardiology and Infectious Diseases are now following up with additional patients who were recently diagnosed with Kawasaki disease at the beginning stages of the coronavirus pandemic to test them for antibodies of the virus causing COVID-19. Test results will help doctors carefully evaluate patients for MIS-C and supply them with more information to better understand the impact of the novel coronavirus on the pediatric population. 

Children’s Hospital Los Angeles is a pioneer in treatment and research for Kawasaki disease and is committed to providing the best possible care for these patients as well as those suffering from the full spectrum of MIS-C disease, including the most ill patients with shock. “I am confident that each child is getting the care that they need promptly from a multidisciplinary team of specialists who are devoted to their individual care plan,” says Dr. Szmuszkovicz. “The reason that every member of the CHLA team comes to work every day is to take care of children. That is why we are all here.” 

Learn More

Visit this webpage to find out what parents should know about MIS-C.