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Multisystem inflammatory syndrome in children (MISC), a rare and underdiagnosed complication of COVID-19: LA Times

2020-05-25

Madagascar periwinkle–photo by PixArc courtesy of pixabay.com

The Los Angeles Times has an article in its May 22 science section about the Multisystem Inflammatory Syndrome in Children (MIS-C) that has been appearing since the pandemic started.  This condition is very rare but has killed at least three children recently.  It resembles Kawasaki disease (fever, rash, and swelling of hands and feet)– which occurs in about 5,500 children in the US every year– and occurs some three weeks after infection.  Kawasaki disease usually affects younger children, mostly under 5, but MIS-C can occur as old as adolescence.

The symptoms of MIS-C also include red eyes and tongue, abdominal pain, low blood pressure, and diarrhea.  In some cases, it resembles toxic shock syndrome (a condition that occurs when infection causes a reaction with low blood pressure, rash, and prostration) that happens rarely after a tampon is infected with toxin-generating bacteria.

Since the syndrome appears so long after SARS-COV-2 infection, most patients will test negative on the nasopharyngeal swab that detects the antigen.  Instead, an antibody test on the blood is required.  Four patients in Los Angeles had antibody-proven COVID-19 and later developed MIS-C.

Treatment of MIS-C is supportive, similar to treating Kawasaki disease.  First, intravenous immunoglobulin is given, just as plasma from recovered COVID-19 patients has been tried in adults.  Repeat doses of immunoglobulin are often needed.  Aspirin, steroids, and cytokine blockers are added.  Anticoagulants and platelet blockers are needed for the blood-clotting complications.

Three of the four patients treated at Children’s Hospital of Los Angeles have recovered.  The fourth is improving and out of the intensive care unit.  The condition was actually first noticed in the United Kingdom (UK) about a month after the pandemic started; it has not been described in China.  The second place it was found was in New York City, where the pandemic was raging last month.  Three children there have died.

The cause of Kawasaki Disease is unknown; some believe that it is due to some environmental element, such as an infection.  MIS-C is clearly related to the pandemic of COVID-19, but there is suspicion that a genetic element is at work making some children more susceptible.  Further study of the few cases that have appeared is ongoing.

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