Multisystem Inflammatory Syndrome (MIS-C) is a rare but serious inflammatory condition seen in children that is a delayed immune response to COVID-19. The MHA and Michigan’s Children’s Hospitals posted a letter on April 28, 2021 saying that MIS-C is most likely to appear 2-5 weeks after COVID-19 surge based on analysis recently published in JAMA Pediatrics.
Case Definition
The CDC provided a case definition for MIS-C in a health advisory:
- An individual under 21 years presenting with fever*, laboratory evidence of inflammation**, and evidence of clinically severe illness requiring hospitalization with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic, or neurological); and
- No alternative plausible diagnoses; and
- Positive for current or recent SARS-CoV-2 infection by reverse-transcriptase polymerase chain reaction, serology, or antigen test; or COVID-19 exposure within the four weeks prior to the onset of symptoms.
*Fever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours
**Including, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin
Additional comments:
- Some individuals may fulfill full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C.
- Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection.
Guidance for Parents
Parents should be aware of MIS-C if their child was exposed to COVID-19 and later develops a fever without other explanation, and gastrointestinal symptoms (abdominal pain, vomiting, and/or diarrhea); rash or red eyes; and less commonly respiratory symptoms (cough, shortness of breath, or chest pain/discomfort).
Parents should seek emergency care right away if their child experiences any of the following warning signs:
- Trouble breathing
- Pain or pressure in the chest that does not go away
- New confusion
- Inability to wake or stay awake
- Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
- Severe abdominal pain
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