MIS-C related to SARS-CoV-2 infection: a narrative review of presentation, differential diagnosis, and management

Abstract

Multisystem Inflammatory Syndrome in Children (MIS-C), a rare condition, has been reported approxi-mately 2-4 weeks after the onset of COVID-19 in children and adolescents, causing inflammation in multiple systems, including cardiovascular and respiratory, digestive, and central nervous systems. This condition is also known as hyperinflammatory shock, Kawa-saki-like disease, and Pediatric Inflammatory Multi-system Syndrome (PIMS). The signs and symptoms include but are not limited to fever, rash, peripheral edema, gastrointestinal symptoms, conjunctivitis, and shock. Thirty-eight studies met our criteria, with a to-tal of 5822 patients. The most affected population was between 5-18 years of age. We noted that MIS-C pre-sented with a wide range of signs and symptoms that overlap with Kawasaki Disease, including high fever, sore throat, malaise, tachypnea, tachycardia, conjunc-tival injection, mucosal edema, cardiac involvement, and gastrointestinal symptoms. It causes an increase in IL-17A, IL-6, and arterial damage, a distinct differ-ence from Kawasaki disease. The laboratory findings in MIS-C showed an increase in inflammatory markers like CRP, ESR, ferritin, leukocytes, and TNF-α. WHO stated that 23% of affected children with MIS-C had underlying conditions like chronic lung diseases, cardiovascular disease, and immunosuppression. In most affected children, aspirin and IVIG were success-ful, which resulted in a decrease in the inflammatory markers. We find that MIS-C is a rare, but potential-ly fatal pediatric complication, after COVID-19 infec-tion. The aim of this article is to study the emerging relationship between COVID-19 and MIS-C in children and adolescents affected by this condition, to discuss the immunological mechanisms, and explore potential therapies.