Multisystem Inflammatory Syndrome in Children (MIS-C)

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Multisystem Inflammatory Syndrome in Children (MIS-C)

MIS-C occurs approximately 2-6 wks after the initial SARS-CoV-2 infection.
Review the following clinical and laboratory criteria when there is concern for diagnosis of MIS-C.
Given the very low prevalence of MIS-C, the CHOP MIS-C Clinical Pathway has been retired. Always review a broad differential for the child’s signs and symptoms.
When the disease is suspected, consult local experts in rheumatology, infectious disease, and cardiology to guide laboratory testing, diagnosis, and treatment.

Current CDC Case Definition for MIS-C

Any illness in a person < 21 yrs of age that meets the following criteria:
- Confirmed Case: Clinical and laboratory criteria
- Probable Case: Clinical and epidemiologic linkage criteria

Note
Meeting a “case definition” is not equivalent to “diagnostic criteria.” The MIS-C case definition may be less predictive of an MIS-C diagnosis currently since the prevalence of MIS-C is thought to be extremely low.

Clinical Criteria	Laboratory Criteria	Epidemiologic Linkage Criteria
Illness characterized by all of the following, in the absence of a more likely alternative diagnosis: Subjective or documented fever, T ≥ 38.0°C Clinical severity requiring hospitalization or resulting in death Evidence of systemic inflammation indicated by CRP ≥ 3.0 mg/dL and New onset manifestations in at least two of the following categories: Cardiac involvement indicated by Left ventricular ejection fraction < 55% or Coronary artery dilation or aneurysm or Elevated troponin level Mucocutaneous involvement indicated by Rash or Inflammation of the oral mucosa e.g., mucosal erythema or swelling, drying or fissuring of the lips, strawberry tongue or Conjunctival injection or Extremity findings e.g., erythema or edema of the hands or feet Shock Gastrointestinal involvement indicated by Abdominal pain or vomiting or diarrhea Hematologic involvement indicated by Platelet count < 150,000 cells/μL or Absolute lymphocyte count (ALC) < 1,000 cells/μL	Detection of SARS-CoV-2 RNA in a clinical specimen up to 60 days prior to or during hospitalization or in a post-mortem specimen using a diagnostic molecular amplification test e.g., polymerase chain reaction (PCR) or Detection of SARS-CoV-2 specific antigen in a clinical specimen up to 60 days prior to or during hospitalization or in a post-mortem specimen or Detection of SARS-CoV-2 specific antibodies in serum, plasma or whole blood associated with current illness resulting in or during hospitalization	Close contact with a confirmed or probable case of COVID-19 disease in the 60 days prior to hospitalization

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.