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Multisystem Inflammatory Syndrome in Children (MIS-C)

Severe post-infectious hyperinflammatory syndrome in children developing 2–6 weeks after SARS-CoV-2 exposure, characterized by persistent fever, multiorgan involvement (cardiac, gastrointestinal, mucocutaneous, hematologic), and shock-like presentation requiring intravenous immunoglobulin and steroids.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Çocuk Sağlığı ve Hastalıkları department. Book Appointment →

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

Multisystem inflammatory syndrome in children (MIS-C), also called pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), is a postinfectious hyperinflammatory disorder appearing 2–6 weeks after symptomatic or asymptomatic SARS-CoV-2 infection, with overlapping features of Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome.

Pathophysiology involves dysregulated immune response with elevated cytokines (IL-6, IL-10, TNF-α), endothelial activation, formation of antigen-antibody complexes, and superantigen-like T-cell activation, leading to widespread vasculitis, myocardial dysfunction, and multiorgan involvement.

Diagnosis follows WHO/CDC criteria: persistent fever, evidence of systemic inflammation (elevated CRP, ferritin, D-dimer, procalcitonin), multiorgan involvement (cardiac, gastrointestinal, hematologic, renal, mucocutaneous, neurologic), recent SARS-CoV-2 infection or exposure, and exclusion of alternative diagnoses.

Symptoms

Persistent fever for 3–5 days or more, often high and unresponsive to antipyretics
Gastrointestinal symptoms: abdominal pain, vomiting, diarrhea (often prominent and may mimic appendicitis)
Mucocutaneous features: bilateral non-purulent conjunctivitis, lip cracking, strawberry tongue, polymorphic rash, swelling of hands and feet
Cardiac involvement: tachycardia, hypotension, myocarditis, ventricular dysfunction, coronary artery dilation or aneurysm
Shock-like presentation: poor perfusion, altered mental status, oliguria, lactic acidosis
Hematologic and laboratory abnormalities: lymphopenia, thrombocytopenia, elevated troponin, BNP, D-dimer, ferritin

Risk Factors

Recent SARS-CoV-2 infection or close contact, often 2–6 weeks before presentation
Age 5–13 years more commonly affected; very young infants and adolescents less common
Male predominance and higher incidence in Black, Hispanic, and South Asian children in some cohorts
Obesity and underlying chronic conditions (asthma, type 2 diabetes) may increase severity
Lower vaccination rates correlate with higher MIS-C risk in some populations
Immunocompromise potentially modifying clinical presentation and outcome

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Child with persistent fever and any of: abdominal pain, rash, conjunctivitis, lethargy, or shock — emergency department evaluation with full workup
  • Recent COVID-19 infection or exposure with new-onset multiorgan symptoms — urgent pediatric assessment
  • Suspected MIS-C with hemodynamic instability — pediatric intensive care unit transfer for hemodynamic and inflammatory management
  • MIS-C survivor in the recovery phase — cardiology follow-up with echocardiography for coronary aneurysm and ventricular function surveillance
  • Long-term sequelae (fatigue, exercise intolerance, anxiety) — multidisciplinary pediatric rehabilitation

Treatment Methods

01
Initial stabilization in pediatric intensive care: fluid resuscitation cautious in cardiac dysfunction, vasopressor or inotrope support, oxygen, mechanical ventilation if needed
02
Intravenous immunoglobulin (IVIG) 2 g/kg as first-line immunomodulation, with or without methylprednisolone (1–2 mg/kg/day) depending on severity
03
High-dose corticosteroids and biologics (anakinra, infliximab, tocilizumab) in IVIG-refractory or severe cases with persistent inflammation
04
Antiplatelet therapy (low-dose aspirin) and anticoagulation (low molecular weight heparin) per coronary involvement and thrombotic risk assessment
05
Long-term follow-up with serial echocardiography, cardiology surveillance for coronary artery dilation, and rehabilitation for cardiac and neurocognitive recovery

Which Department to Visit?

You can visit our Çocuk Sağlığı ve Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.