Children and adolescents
Multisystem inflammatory syndrome in children (MIS-C)
Fever with high CRP and illness in two or more organ systems after SARS-CoV-2 infection or exposure.
What to look for
- CDC definition (2023): age under 21, fever of 38.0 °C or higher, CRP of 3.0 mg/dL or higher, and illness needing hospitalization (or resulting in death)
- New involvement in at least 2 categories: cardiac (reduced EF, coronary dilation or aneurysm, raised troponin), mucocutaneous, shock, gastrointestinal, or hematologic (platelets under 150,000 or lymphocytes under 1,000)
- Lab or epidemiologic evidence of SARS-CoV-2 within the prior 60 days, and no more likely alternative diagnosis (including Kawasaki disease)
What to do
- Admit for multidisciplinary care with rheumatology, cardiology, infectious disease and critical care as needed.
- Echocardiogram, ECG, troponin and BNP. Treatment usually includes IVIG and/or glucocorticoids, with antithrombotic therapy per protocol.
About this urgency level
Call rheumatology directly. Many of these need the emergency department or admission, and treatment often starts before the specialist visit.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.
Sources