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coVid-19-associated

MuLtisYsteM

infLaMMatoRY

sYndRoMe in cHiLdRen

t he first case of Coronavirus disease 2019 (COVID-19)

caused by severe acute respiratory syndrome
Coronavirus 2 (SARS-CoV-2) was reported in
Wuhan, China in late December 2019. By the end
of January 2020, the World Health Organization (WHO)
declared this disease a global health emergency. Since
then, COVID-19 has claimed innumerable lives globally.

Fortunately, most children have not become seriously
ill with COVID-19. Their symptoms have generally been
milder, and less severe than those experienced by the
adults. However, since around May 2020, a small number
of children have been observed to develop an unusual
condition which seems to be linked to the virus.
By Dr Denise Parris (Paediatric Pulmonologist) and Dr Priya R
This condition has been termed Multisystem Inflammatory

Syndrome in Children (MIS-C). Other names also used Ambaram (Paediatric Rheumatologist),
intermittently for this same condition include Paediatric Netcare Waterfall City
Multisystem Inflammatory Syndrome (PMIS/PIMS), Paediatric

Multisystem Syndrome temporally associated with

SARS-CoV-2 infection (PIMS-TS), Paediatric Inflammatory

Syndrome, or Paediatric Hyperinflammatory Shock. KD is a self-limited vasculitis of childhood where patients
may present with a persistently raised fever, rashes, as
What is MIS-C? well as inflammation of blood vessels, especially the

This is a condition seen in children who have been coronary arteries (blood vessels of the heart). Toxic
previously infected with SARS-CoV-2, (some may not even Shock Syndrome is a rare life-threatening clinical illness
know that they were infected by the virus), recovered that occurs, usually as a result of bacterial toxins, and is
from it, and then later (which can be up to 6 weeks after characterised by a rapid onset of fever, a rash, low blood
infection) present with an immune response that results pressure and multi-organ involvement. Macrophage

in significant inflammation in different organ systems. This activation syndrome is also a potentially life-threatening

inflammation can spread to the blood vessels, causing complication that may be associated with a viral infection or

what is known as vasculitis (inflammation of blood vessels), as a complication of Kawasaki disease or other autoimmune

especially involving the vessels surrounding the heart. diseases. Patients may present with similar symptoms
(as previously mentioned) including a fever, enlarged
If left untreated, the inflammation can cause tissue lymph nodes, liver and spleen plus marked systemic

damage, organ failure and even death. Some of the inflammation with multi-organ involvement as well.

symptoms can overlap with other rare conditions
like Kawasaki Disease (KD), Toxic Shock Syndrome or When does MIS-C present?
Macrophage Activation Syndrome. Some specialists Usually this condition presents anything from 2 - 6 weeks
have also referred to MIS-C as a ‘Kawasaki-like disease’. after COVID-19 exposure. Most studies clearly demonstrate
20 Waterfall Issue 10 2020