Multi-System Inflammatory Syndrome in Children in Association with COVID-19.
Simpson JM, Newburger JW.
Circulation. 2020 Jun 11. doi: 10.1161/CIRCULATIONAHA.120.048726. Online ahead of print.
Take Home Points:
- Multisystem inflammation in children (MIS-C) is a newly recognized syndrome mimicking Kawasaki disease in some aspects of clinical presentation and clinical course temporally associated with COVID-19 infection.
- Multisystem inflammatory syndrome in children shares similarities with atypical Kawasaki disease, however, clinical criteria of diagnosis of Kawasaki disease was not fulfilled.
- Coronary dilation including giant aneurysm can happen.
- Markers of inflammation and cardiac involvement—including troponin I, brain natriuretic peptide, D-dimer, C-reactive protein, and interleukin 6—were all elevated.
- Left ventricular systolic dysfunction requiring ionotropic support is common.
- Additional studies are needed to determine the longer-term impact of MIS-C on myocardial function and coronary arteries.
- The optimal treatment for MIS-C is uncertain. Patients are often treated with immunomodulatory therapy including intravenous immunoglobulin and steroids. In more severe cases e anakinra, infliximab, or tocilizumab has been used.
Comment from Dr. Shaji Menon (Salt Lake City, Utah), section editor of Pediatric Cardiology Journal Watch: This article is an excellent commentary on the above discussed original article by Simpson and Newburger.