Doctors push for awareness of MIS-C as S.C. marks first death from COVID-related syndrome

January 30, 2021
graphic in MUSC colors with the word MIS-C
Although MIS-C remains a rare complication of COVID-19, doctors say it shouldn't be overlooked as a possibility if a child has a prolonged fever with no obvious cause.

As South Carolina marks its first death from multisystem inflammatory syndrome in children, or MIS-C, doctors from MUSC Children’s Health have a simple message for parents:

If your child has a fever for more than three days with no obvious cause, ask the child’s doctor if it could be MIS-C.

MIS-C is a complication of COVID-19. It remains rare. As of Jan. 8, there have been fewer than 1,700 cases and just 26 deaths reported nationwide. Unfortunately, because it is so rare, doctors sometimes don’t consider that a child could be suffering from MIS-C.

Many of the children who have been treated at the MUSC Shawn Jenkins Children’s Hospital ended up there because they became incredibly ill after going to emergency rooms three, four or five times without anyone raising the possibility of MIS-C, said Allison Eckard, M.D., division chief for pediatric infectious diseases at MUSC Children’s Health. She is also leading a study at MUSC investigating a novel therapy to treat children with MIS-C who have developed cardiac complications. And as the number of COVID-19 cases increases across the state, the number of children with this rare complication is bound to rise as well.

“Yes, this is very rare, but the more COVID there is in the community, the more cases of MIS-C we will see,” Eckard said.

"Yes, this is very rare, but the more COVID there is in the community, the more cases of MIS-C we will see."

Allison Eckard, M.D.

MIS-C is a delayed inflammatory response to the novel coronavirus. The body overreacts and sets off a cascade of inflammation that can overwhelm the organs, she said. Some patients might not even realize they had the initial coronavirus infection because it was so mild.

MUSC Children’s Health has treated 16 patients for MIS-C. All have ultimately done well, although a number of them were sick enough to require intubation or treatment with ECMO, a machine that does the work of the heart and lungs.

A key point, Eckard said, is that most of the children were perfectly healthy before coming down with MIS-C. Only one child had a preexisting condition, and Eckard thinks that condition probably didn’t factor into the MIS-C diagnosis.

“We don’t know which children are going to have more severe MIS-C than other children, and not all of them are this sick, but most of them require hospitalization and some amount of therapy. And the sooner the therapy, the better,” she said.

Christopher Pruitt, M.D., medical director of the Emergency Department at the MUSC Shawn Jenkins Children’s Hospital, echoed Eckard’s message that parents should ask about MIS-C if a doctor doesn’t bring it up.

Because fevers are so commonly seen in emergency rooms and urgent care centers, and MIS-C is so rare, it’s a diagnosis that often isn’t top of mind for providers, he said.

“We see so many kids with fever that we really have to actively flip into that mindset of thinking of MIS-C as a diagnostic possibility,” he said.

In addition, the understanding of and guidelines for dealing with MIS-C continue to evolve as doctors and scientists learn more.

“There’s no gold standard for diagnosing it. It’s a constellation of clinical symptoms, along with lab tests, along with indication of recent COVID infection, but some of those things may be absent depending on the case,” he said.

Pruitt said Emergency Department doctors at MUSC Children’s Health are always available for consultation if community providers have questions.

“If you have concerns, just call,” he said.

The average age of a MIS-C patient is 8 years old, but the syndrome has been diagnosed in babies and young adults up to 20 years old.

Parents should also consider MIS-C if there’s no explanation for a child’s illness, Eckard said.

“They know their children the best,” she said. “If their child is not acting right, has a rash that is different than they’ve ever had and particularly if he or she has a high fever without an obvious reason – parents need to ask their provider, ‘Is it possible that my child has MIS-C?’”