Multisystem inflammatory syndrome in children (MIS-C): Clinical presentation and management of critically ill cases

Abstract

We present a series of three critically ill pediatric patients, aged 6–10 years, who were diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C) following a recent SARS-CoV-2 infection. These cases were admitted to a tertiary care center in New Jersey between April 4 and May 10, 2020. All patients were previously healthy, and their clinical presentations were characterized by fever, abdominal pain, gastrointestinal symptoms, and/or rash. One patient exhibited altered mental status with cerebrospinal fluid findings consistent with aseptic meningitis. Laboratory results revealed markedly elevated C-reactive protein (CRP), D-dimer, B-type natriuretic peptide (BNP), and troponin levels, alongside low albumin levels in all cases. Notably, evaluation for alternative infections was negative. All patients developed circulatory shock requiring inotropic support, with two requiring advanced respiratory support and one presenting with cardiac dysfunction. Treatment included corticosteroids for all patients, with two receiving intravenous immunoglobulin (IVIG) and one receiving tocilizumab. All patients survived without fatal outcomes. This report underscores the importance of clinical awareness of MIS-C, particularly in the context of SARS-CoV-2, to guide effective management and improve patient outcomes.