Join us   Log in  


Pages: 36-40

Date of Publication: 15-Apr-2021

Print Article   Download XML  Download PDF


Author: Simona Cainap, Alexandra Mititelu, Oana Pantar, Diana Lazar

Category: Medical


Multisystem Inflammatory Syndrome associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children.

This syndrome is characterized by fever, abdominal pain, gastrointestinal and cutaneous symptoms, and hemodynamic alterations. MIS-C has similar features to those of Kawasaki disease (KD), toxic shock syndrome (TSS), macrophage-activation syndrome, bacterial sepsis, meningitis.

MIS-C is defined as a typically progressive disease. Patients who initially had mild symptoms can develop severe illness with multi-organ dysfunction a few days after symptom onset.

The majority of affected children were treated with intravenous immune globulin (IVIG), and several also received adjunctive high-dose steroids.

The pediatricians should be aware about this new and potentially life threatening condition in children during COVID-19 epidemics.

Keywords: Covid-19, Multisystemic inflammatory syndrome, children

DOI: 10.51546/JSUM.2021.8106



  1. Chengdi Wang, Zhoufeng Wang, Guangyu Wang, Johnson Yiu-Nam Lau, Kang Zhang, Weimin L. COVID-19 in early 2021: current status and looking forward. Signal Transduct Target Ther. 2021;6:114. Published online 2021 Mar 8. doi: 10.1038/s41392-021-00527-1
  2. Lee PI, Hu YL, Chen PY, Huang YC, Hsueh PR. Are children less susceptible to COVID-19? J Microbiol Immunol Infect. 2020;53:371–2.
  3. CDC COVID-19 Response Team. Coronavirus disease 2019 in children—United States, February 12–April 2, 2020. Morb. Mortal. Wkly. Rep. 2020, 69, 422–426.
  4. Choi S-H, Kim HW, Kang J-M et al. Epidemiology and clinical features of coronavirus disease 2019 in children. Clin Exp Pediatr 2020; 63(4):125.
  5. Dong Y, Mo X, Hu Y et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. J Emerg Med 2020;58(4):712–713. jemermed.2020.04.006
  6. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinfammatory shock in children during COVID-19 pandemic. Lancet. 2020;395:1607–1608
  7. Royal College of Paediatrics and Child Health. Guidance: paediatric multisystem inflammatory syndrome temporally associated with COVID-19.
  8. Centers for Disease Control and Prevention. Emergency preparedness and response: health alert network. han/2020/han00432.asp
  9. World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19. Published May 15,2020
  10. Cavalli G, De Luca G, Campochiaro C, Della-Torre E, Ripa M, Canetti D, et al. Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study. Lancet Rheumatol. 2020;2:e325–31. doi: 10.1016/S2665-9913(20)30127-2
  11. Dolinger MT, Person H, Smith R, Jarchin L, Pittman N, Dubinsky MC, et al. Pediatric Crohn's disease and multisystem inflammatory syndrome in children (MIS-C) and COVID-19 treated with infliximab. J Pediatr Gastroenterol Nutr. 2020;2:153–5. doi: 10.1097/MPG.0000000000002809
  12. Schvartz A, Belot A, Kone-Paut I. Pediatric Inflammatory Multisystem Syndrome and Rheumatic Diseases During SARS-CoV-2 Pandemic. Front. Pediatr. 2020 |
  13. Belhadjer Z, Méot M, Bajolle F et al. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic. Circulation. 2020;33. 10.1161/CIRCULATIONAHA.120.048360 [PubMed]
  14. Blondiaux E, Parison P, Redheuil A, et al. Cardiac MRI of children with multisystem inflammatory syndrome (MIS-C) associated with COVID-19: case series Eléonore. Radiology. 2012;78:1–15
  15. Grimaud M, Starck J, Levy M et al. Acute myocarditis and multisystem inflammatory emerging disease following SARSCoV-2 infection in critically ill children. Ann Intensive Care. 2020;10: 1–5.
  16. Wolfler A, Mannarino S, Giacomet V et al. Acute myocardial injury: a novel clinical pattern in children with COVID-19. Lancet child Adolesc Heal.2020;4642:1016–1017. 1016/S2352-4642(20)30168-1
  17. Rubens JH, Akindele NP, Tschudy MM, Sick-Samuels AC. Acute covid-19 and multisystem inflammatory syndrome in children BMJ 2021;372:n385 doi:10.1136/bmj.n385
  18. Pouletty M, Borocco C, Ouldali N, Caseris M, Basmaci R, Lachaume N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis. 2020;79:999–1006. doi: 10.1136/annrheumdis-2020-217960
  19. Laing AG, Lorenc A, del Molino del Barrio I, Das A, Fish M, Monin L, et al. A dynamic COVID-19 immune signature includes associations with poor prognosis. Nat Med. 2020; 26:1623–35. doi: 10.1038/s41591-020-1038-6
  20. Licciardi F, Pruccoli G, Denina M, Parodi E, Taglietto M, Rosati S, et al. SARS-CoV-2-Induced Kawasaki-like hyperinflammatory syndrome: a novel COVID phenotype in children. Pediatrics. 2020;146:e20201711. doi: 10.1542/peds.2020-1711
  21. Pilania RK, Jindal AK, Bhattarai D, Naganur SH, Singh S. Cardiovascular Involvement in Kawasaki Disease Is Much More Than Mere Coronary Arteritis. Front Pediatr. 2020;24;8:526969. doi: 10.3389/fped.2020.526969. PMID: 33072669; PMCID: PMC7542237.
  22. Cattalini M, Taddio A, Bracaglia C et al. Rheumatology Study Group of the Italian Society of Pediatrics. Childhood multisystem inflammatory syndrome associated with COVID-19 (MIS-C): a diagnostic and treatment guidance from the Rheumatology Study Group of the Italian Society of Pediatrics. Ital J Pediatr. 2021;47(1):24. doi: 10.1186/s13052-021-00980-2. PMID: 33557873; PMCID: PMC7868856.
  23. Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID-19. J Cardiovasc Electrophysiol. 2020;31(5):1003-1008. doi: 10.1111/jce.14479. Epub 2020 Apr 13. PMID: 32270559; PMCID: PMC7262150.
  24. Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, et al. American College of Rheumatology Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS?C) Associated with SARS?CoV?2 and Hyperinflammation in COVID?19. Version 1. Arthritis Rheumatol 2020;72:1791-1805. doi:
  25. Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383:334–46. doi: 10.1056/NEJMoa2021680
  26. Wright FL, Vogler TO, Moore EE et al. Fibrinolysis shutdown correlates to thromboembolic events in severe COVID-19 infection. J Am Coll Surg. 2020:1–11. 10.1016/j.jamcollsurg.2020.05.007 [PMC free article] [PubMed]
  27. Esposito, S., Principi, N. Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2. Pediatr Drugs. 2021; 23:119–129.