Recently, a possible link has been reported between COVID-19 and a serious inflammatory response that affects multiple organs, including the heart. Multisystem Inflammatory Syndrome in Children (MIS-C) is a relatively rare, but serious complication of COVID-19 in children. One of the first known cases of MIS-C was diagnosed in April of 2020 and was successfully treated by the team at Ochsner Hospital for Children.

How does COVID-19 affect children?

Children are less likely to become symptomatic with the novel coronavirus than adults. Of the children who are symptomatic with COVID-19, most have very mild symptoms, including cold-like symptoms, fever, headache, sore throat and cough. Some children have abdominal pain, vomiting or diarrhea.

What is Multisystem Inflammatory Syndrome in Children?

MIS-C is a hyper response by the body’s immune system to a recent COVID-19 infection. It usually occurs about 2-6 weeks after an infection with COVID-19, many times in children who had an asymptomatic COVID-19 infection. This syndrome has features that overlap with Kawasaki disease and toxic shock syndrome. Kawasaki disease is caused by inflammation or irritation of blood vessels and tends to affect the coronary arteries, which supply blood to the heart. Toxic shock syndrome is a rare but life-threatening complication of an infection and causes fever, rash and low blood pressure, and can result in damage to multiple organs.

Patients with MIS-C have fever, abdominal pain, trouble breathing, chest pain, evidence of inflammation on laboratory testing and dysfunction of at least one organ system (kidney, heart, brain or gastrointestinal tract). This syndrome has been reported in patients who test both positive and negative for COVID-19 by nasal swab, but almost always with positive antibodies to COVID-19 by blood tests.

What are the more common symptoms?

• Fever
• Severe abdominal pain, vomiting, diarrhea
• Sore throat
• Trouble breathing
• Chest pain
• Conjunctivitis (pink eye)
• Rash
• Swollen or peeling hands or feet
• Swollen, red or chapped lips
• Swollen lymph nodes

How is MIS-C diagnosed?

Children with suspected inflammatory response should be evaluated promptly. In addition to a history and physical examination, patients are likely to need X-rays, blood tests and a nasal swab to test for COVID-19. Some children will need cardiac evaluation with an electrocardiogram and/or echocardiogram.

What is the treatment?

Children may require close monitoring in the pediatric intensive care unit. The primary means of treatment is supportive care, including IV fluids, oxygen or respiratory support and medications that support blood pressure. In addition, several medications that are commonly used to treat Kawasaki disease and toxic shock syndrome are being used to treat this inflammatory syndrome, including intravenous immunoglobulin, steroids and medications that alter the immune response.

The team at Ochsner Hospital for Children have become national leaders in treating this condition. For more information, visit http://ldh.la.gov/Coronavirus/

The information in this blog post is accurate at the time of publication. However, as the situation surrounding COVID-19 continues to change, it's possible that information has changed since being published. While Ochsner Health is trying to keep our blog posts as up-to-date as possible, we also encourage readers to stay informed on news and recommendations by using the CDC website.