SC sees increase in MIS-C, a rare COVID complication in children

August 20, 2020
MIS-C in South Carolina
MIS-C tends to hit kids who are elementary or middle schoolers.

More than a dozen kids in South Carolina have developed MIS-C, which stands for multisystem inflammatory syndrome in children. It’s a rare but dangerous complication of COVID-19. Six of the children have been treated at MUSC Children’s Health.

Pediatric critical care intensivist Elizabeth Mack, M.D., is among the doctors taking care of those kids at MUSC Children’s Health. She’s trying to raise awareness about the condition. “A lot of these kids have been seen by medical professionals a few times and we need people to know it’s out there.”

Mack, a professor in the College of Medicine at the Medical University of South Carolina and division chief of Pediatric Critical Care Medicine, described the symptoms of MIS-C. “A lot of these kids have had a high fever for several days without an obvious cause. They can have several nonspecific symptoms including swollen lymph nodes, a rash, swollen, red or peeling hands or feet, red eyes and abdominal pain,” she said.

Dr. Elizabeth Mack 
Dr. Elizabeth Mack

“They can also get what we call a strawberry tongue — it’s a really bright red, bumpy tongue. Most of them aren’t eating. Some are vomiting and/or having diarrhea. These are not well-looking kids. They’re usually really puny.”

Once the children are diagnosed with MIS-C, doctors can treat the condition for what it is: a delayed and harmful immune system response to COVID-19 that causes inflammation throughout the body. It can lead to long-term heart problems. MIS-C has also caused 10 deaths across the country but none in South Carolina.

“We treat it like Kawasaki disease, which involves IVIG, an immune modulator. This is one of the very rare cases where we use aspirin in children in order to try to prevent the heart effects. We may also use steroids. And in some severe cases, which we’ve had a few of, we’re using other immune modulating drugs in consultation with our rheumatologists and immunologists,” Mack said.

MUSC Children’s Health is also testing a possible treatment for MIS-C called remestemcel-L, which goes by the brand name Ryoncil. It uses cells from the bone marrow of healthy people that have been expanded in a lab to try to combat the syndrome’s harmful response.

Mack said MIS-C shows up a few weeks after a child is infected with COVID-19. These children may have mild symptoms or no symptoms, so they may not know they had an infection at all. MIS-C typically affects kids who are elementary or middle school age. Nationally, more than 70% of MIS-C cases have been in children who are Black or Hispanic/Latino, according to the Centers for Disease Control and Prevention.

MUSC Children's Health has formed an MIS-C team with critical care, rheumatology, hematology, infectious disease, cardiology, hospital medicine and immunology specialists to review each potential case. It's unclear how the state's declining number of new COVID infections will affect the number of kids suffering from the syndrome. “We’re not sure what direction this will go – if it will continue to rise or it will fall. You can think of it as a delayed marker of COVID,” Mack said.

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