COVID-19 in children: multisystem inflammatory syndrome




COVID-19, pediatric inflammatory multisystem syndrome, pediatric multisystem inflammatory disease, COVID-19 related, MIS-C associated with COVID-19, PIMS-TS


Unlike adults, children are less likely to get infected SARS-CoV-2, their disease has a mild form and fatal cases are rather rare. However, a new disease associated with SARS-CoV-2, the multisystem inflammatory syndrome (MIS-C), has been described in children. Most children with MIS-C in the world are blacks or asians.

Purpose - to analyze of peculiarities of MIS-C in children of Lviv Region.

Materials and methods. We have analyzed medical records of 16 children who were treated in Communal Non-Commercial Establishment of Lviv Regional Council «Lviv Regional Children Clinical Hospital «OKHMATDYT» in the period from September 2020 to January 2021 with the diagnosis of MIS-C, associated with SARS-CoV-2.

Results. MIS-C was diagnosed in 16 children (average age was 8,2±0,065 years, girls:boys = 1:0,6). None of our patients was the «primary source of SARS-CoV-2» in the household but contracted coronavirus disease after a contact with the sick relatives. The disease occurred in 4 (25%) children against the background of acute coronavirus disease, in 4 (25%) more children during the first month and 8 (50%) children more than a month after acute SARS-CoV-2 infection. All children has febrile fever and general weakness. Besides, in most of the patients clinical progression of MIS-C was characterized by typical skin rashes and conjunctivitis (13 children - 81,5%), facial swelling and edema of distal parts of extremities (11 children - 68,75%). Muscle pain was present in 9 (56%) children, hyperesthesia - in 4 (25%) children, gastrointestinal symptoms - in 8 (50%) our patients. Myocarditis was diagnosed in 4 (25%) children, linear dilatation of coronary arteries (2 children - 12,5%) and small aneurysms (1 child - 6,25%) - in 3 (18,75%) our patients. All these changes returned to normal 1 month after discharge from the hospital.

Conclusions. The syndrome of multisystem inflammatory response before the 48th day after acute coronavirus disease and is characterized by typical clinical course. Treatment with human immunoglobulin at the dose of 1-2 g/kg, glucocorticosteroids at the dose of 1-2 mg/kg, aspirin 3-5 mg/kg against the background of antibacterial therapy is effective for the prevention of changes in the coronary arteries and for the recovery of all patients.

The research was conducted in accordance with the principles of bioethics set out in the WMA Declaration of Helsinki and Universal Declaration on Bioethics and was approved by the Commission on Ethics of Scientific Research, Experimental Developments and Scientific Works of Danylo Halytsky Lviv National Medical University. The informed consent of the patients was obtained for conducting the studies.

No conflict of interests was declared by the authors.


Ahmed M, Advani S, Moreira A, Zoretic S at al. (2020, Sep). Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine. 26: 100527.; PMid:32923992 PMCid:PMC7473262

Antomonov MY. (2018). Mathematical processing and analysis of medical and biologic data. 2-d ed. Kyiv: IIC Medinform: 579.

Aronoff SC, Hall A, Del Vecchio MT. (2020, Dec 31). The Natural History of Severe Acute Respiratory Syndrome Coronavirus 2-Related Multisystem Inflammatory Syndrome in Children: A Systematic Review. J Pediatric Infect Dis Soc. 9 (6): 746-751.; PMid:32924059 PMCid:PMC7797745

Bordet J, Perrier S, Olexa C, Gerout AC at al. (2021, Mar). Paediatric multisystem inflammatory syndrome associated with COVID-19: filling the gap between myocarditis and Kawasaki? Eur J Pediatr. 180 (3): 877-884.

PMid:32959075 PMCid:PMC7505496

Dong E, Du H, Gardner L. (2020, May). An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 20 (5): 533-534. d

Eleftheriou D, Levin M, Shingadia D, Tulloh R, Klein NJ, Brogan PA. (2014, Jan). Management of Kawasaki disease. Arch Dis Child. 99 (1): 74-83.; PMid:24162006 PMCid:PMC3888612

Godfred-Cato S, Bryant B, Leung J, Oster ME at al. (2020, Aug 14). California MIS-C Response Team. COVID-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020. MMWR Morb Mortal Wkly Rep. 69 (32): 1074-1080.; PMid:32790663 PMCid:PMC7440126

Henderson LA, Canna SW, Friedman KG, Gorelik M at al. (2020, Nov). American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 1. Arthritis Rheumatol. 72 (11): 1791-1805.; PMid:32705809 PMCid:PMC7405113

Hennon TR, Penque MD, Abdul-Aziz R, Alibrahim OS at al. (2020, May 23). COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; a Western New York approach. Prog Pediatr Cardiol: 101232.; PMid:32837142 PMCid:PMC7244417

Koné-Paut I, Cimaz R. (2020, Jun). Is it Kawasaki shock syndrome, Kawasaki-like disease or pediatric inflammatory multisystem disease? The importance of semantic in the era of COVID-19 pandemic. RMD Open. 6 (2): e001333.; PMid:32611651 PMCid:PMC7425186

Millar K, Manlhiot C, Yeung RS, Somji Z, McCrindle BW. (2012, Jan 12). Corticosteroid administration for patients with coronary artery aneurysms after Kawasaki disease may be associated with impaired regression. Int J Cardiol. 154 (1): 9-13.; PMid:20851480

Negishi K, Negishi T, Kurosawa K, Hristova K at al. (2015, Apr). Practical guidance in echocardiographic assessment of global longitudinal strain. JACC Cardiovasc Imaging. 8 (4): 489-492.; PMid:25129519

Parri N, Lenge M, Buonsenso D. (2020, Jul 9). Coronavirus Infection in Pediatric Emergency Departments (CONFIDENCE) Research Group. Children with Covid-19 in Pediatric Emergency Departments in Italy. N Engl J Med. 383 (2): 187-190.; PMid:32356945 PMCid:PMC7206930

Shirato K, Imada Y, Kawase M, Nakagaki K, Matsuyama S, Taguchi F. (2014, Dec). Possible involvement of infection with human coronavirus 229E, but not NL63, in Kawasaki disease. J Med Virol. 86 (12): 2146-2153.; PMid:24760654 PMCid:PMC7166330

Whittaker E, Bamford A, Kenny J, Kaforou M at al. (2020, Jul 21). PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical Characteristics of 58 Children with a Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2. JAMA. 324 (3): 259-269.; PMid:32511692 PMCid:PMC7281356

Zhao CN, Du ZD, Gao LL. (2016, Apr). Corticosteroid Therapy Might be Associated with the Development of Coronary Aneurysm in Children with Kawasaki Disease. Chin Med J. 20; 129 (8): 922-928.; PMid:27064036 PMCid:PMC4831526