Patients with MIS-C have presented with a persistent fever, abdominal pain, vomiting, diarrhea, skin rash, mucocutaneous lesions and in severe cases, hypotension and shock.. Patients have elevated inflammatory markers and, in a majority, laboratory markers of damage to the heart.
Not all children will have the same signs and symptoms, and some children may have symptoms not listed here. A child under investigation for MIS-C should also be evaluated for other infectious (e.g. septic shock) and non-infectious (e.g., malignancy) etiologies that may explain the clinical presentation.
MIS-C may begin weeks after a child is infected with SARS-CoV-2. The child may have been infected from an asymptomatic contact and, in some cases, the child and their caregivers may not even know they had been infected.
Most children diagnosed with MIS-C have had laboratory evidence of either past or current COVID-19 infection and the majority have had no documented underlying medical conditions.
Information on laboratory evaluation, treatment, follow-up, and other clinical considerations for patients with suspected or diagnosed MIS-C have been provided by the CDC, American Academy of Pediatrics and a recently published guidance from the American College of Rheumatology which also compares and contrasts features of MIS-C and Kawasaki Disease as well as providing guidance evaluation and treatment.
iFever ≥38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours
iiIncluding, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin
Consider testing any patient for whom MIS-C is a clinical consideration for acute COVID-19 infection (i.e. RT-PCR) and for prior COVID-19 infection (antibody testing).
Testing aimed at identifying laboratory evidence of inflammation as listed in the Case Definition section is warranted. Similarly, SARS-CoV-2 detection by RT-PCR is indicated.
Where feasible, SARS-CoV-2 serology testing is suggested, even in the presence of positive RT-PCR or antigen testing. Any serology testing should be performed prior to administering IVIG or any other exogenous antibody treatments.
Given the frequent association of MIS-C with cardiac involvement, many centers are performing cardiac testing including, but not limited to:
Other testing to evaluate multisystem involvement should be directed by patient signs or symptoms. Additionally, testing to evaluate for other potential diagnoses should be directed by patient signs or symptoms.
Providers are advised to immediately refer patients with a picture of toxic shock or Kawasaki Disease to a specialist in pediatric infectious disease, rheumatology, and/or critical care, as indicated. Early diagnosis and treatment of patients meeting full or partial criteria for Kawasaki disease is critical to preventing end-organ damage and other long-term complications. Providers are advised to immediately refer patients with a picture of toxic shock or Kawasaki Disease to a specialist in pediatric infectious disease, rheumatology, and/or critical care, as indicated. Early diagnosis and treatment of patients meeting full or partial criteria for Kawasaki disease is critical to preventing end-organ damage and other long-term complications.
According to guidelines from the American Academy of Pediatrics the following ICD-10-CM diagnosis codes should be used for a child admitted to the hospital due to documented MIS-C.
U07.1, COVID-19 (principal diagnosis) and M35.8, other specified systemic involvement of connective tissue (secondary diagnosis).
Report cases that meet the CDC definition of Multisystem Inflammatory Syndrome in Children (MIS-C) by phone within 1 working day. Note patients should be reported regardless of SARS-CoV-2 PCR test result.