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Multi-system Inflammatory Syndrome in Children (MIS-C)

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Your child’s medical team is monitoring your child for a possible illness called Multi-system inflammatory syndrome in children (MIS-C).

What is Multi-system Inflammatory Syndrome in Children (MIS-C)?

Multi-system inflammatory syndrome in children (MIS-C), is a rare problem of COVID-19 in children. MIS-C can cause different body parts can become inflamed, which may include the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs (stomach). The syndrome was first reported in spring of 2020. Children who develop MIS-C will have had an exposure to COVID-19 a few weeks before developing signs of MIS-C and may not have had any symptoms of COVID-19 infection. Because MIS-C has a wide range of symptoms that can also be caused from other diseases, some children will have tests done to determine if they have MIS-C. Many children will not have MIS-C but will have other diagnoses.

While children and teens of all ages can get MIS-C, the average age is about 8 years old.

What causes MIS-C?

The exact cause of MIS-C is not known, but it is thought to be related to an abnormal immune system response to the COVID-19 virus. Most children who develop MIS-C will have had an exposure to COVID-19 a few weeks before developing signs of MIS-C. MIS-C is not contagious to other people. However, the virus COVID-19 is very contagious. Some children with MIS-C will still test positive for COVID-19 and the healthcare team will need to wear special protective equipment.

What are the signs of MIS-C?

Children with MIS-C can have a wide range of different symptoms. Most children with MIS-C have fever, often for several days. Gastrointestinal (GI) symptoms such as abdominal (stomach) pain, vomiting, and diarrhea are also common.

Other symptoms include:

  • red, inflamed “ bloodshot” eyes (conjunctivitis)
  • rash
  • red, dry, cracked lips
  • a sore throat
  • swollen hands and feet
  • swollen lymph glands in the neck
  • chest pain
  • trouble breathing
  • sore muscles
  • headache or confusion

How is MIS-C diagnosed?

MIS-C symptoms can look similar to those of other childhood viral and bacterial illnesses. MIS-C symptoms may look similar to symptoms of another rare disease called Kawasaki Syndrome.  To diagnose MIS-C, providers will ask about symptoms (such as a long-lasting fever), do an exam, and perform lab tests. There is no single test to diagnose MIS-C. In some cases, providers may repeat tests over a few days before determining if your child has MIS-C.

If MIS-C looks possible, your provider may:

  • test blood and sometimes urine (pee) samples to rule out other conditions, such as scarlet fever, other viruses, urine infections or juvenile rheumatoid arthritis
  • order tests to check the heart, such as an electrocardiogram (“EKG”) to see how the heart beats and an ultrasound of the heart called echocardiogram (“echo”)
  • tests such as ultrasounds of the abdomen to check for appendicitis if your child has severe abdominal pain

If MIS-C is suspected, your child will have frequent lab draws over the first few days. At times lab tests may need to be drawn several times per day. Your team will do everything possible to minimize the discomfort of lab draws and will decrease the number of labs that need to be drawn as soon as they are able to.

How is MIS-C treated?

Providers usually treat children with MIS-C by:

  • Intravenous (IV) dose of immune globulin (IVIG). Antibodies (proteins) help fight infections and also to remove substances secreted by immune cells that can cause inflammation.
  • Aspirin to treat inflammation. Children take aspirin until told to stop by the heart doctor, usually for several weeks or perhaps months.
  • Steroid medicines to reduce inflammation. In some cases, children are sent home on steroids by mouth in doses that slowly decrease over a few weeks.
  • Antibiotic medicines. MIS-C can look like many other diseases and your providers will be watching labs to make sure there is not a bacterial infection causing the symptoms.
  • Blood thinner medicine. Children with MIS-C are at risk of developing blood clots. This usually needs to be done with injections two times per day.
  • Anti-acid medicine to protect the lining of their stomach from some of the side effects of steroids and other medicines.

Treatment begins as soon as possible. Because MIS-C can look like other diseases, there will often be several specialists involved in their care. These specialists might include infectious disease (“ID”), immunology, cardiology (heart doctors), hematology (blood doctors), and endocrinology, in addition to the primary doctors of the team. This team will discuss your child in detail to determine the best possible treatment plan.  Every diagnosis of MIS-C is different and your child’s care team will work together to adjust your child’s treatment plan.

Most children with MIS-C start to get much better after their first days of treatment, though sometimes additional types of treatment are needed.

Questions?

This information is not specific to your child but provides general information. If you have any questions, please call your clinic.

Reviewed 2/21

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Minnesota Family Resource Center library, or visit www.childrensmn.org/educationmaterials.

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