MIS-C in the Mix: New Algorithm Factors in COVID-19 for Kids with Fever + Rash

As time passes, we are learning more about COVID-19 and how it presents in children. As most PEM providers now know, Multisystem Inflammatory Syndrome in Children, or MIS-C is a hyperinflammatory state likely related to previous exposure to the SARS-CoV-2 virus. There is a spectrum of presentations of MIS-C, but current case definitions include fever and involvement of 2 or more organ systems. One of the organ systems that can be involved is skin. 

There is no rash that has been identified as classic for MIS-C; rather, case reports have described nonspecific rashes or rashes that overlap with “classic rashes” of illness such as varicella. Patients may also present with other signs that are typical for Kawasaki disease. 

While rash and fever are not enough to satisfy the case definition of MIS-C, the clever clinician will search for other symptoms (e.g. neurologic, gastrointestinal) that should trigger additional investigations. Lab testing that shows inflammation should raise suspicion for MIS-C, typically leading to inpatient evaluation, echocardiogram, specialist consultation and treatment with anti-inflammatory medications such as IVIG and/or steroids to reverse the hyperinlflammatory state. 

EB Medicine published a review of the latest evidence on ?Emergency Department Management of Rash and Fever in the Pediatric Patient? in January. Since then, the SARS-CoV-2 virus came into the picture, and more recently MIS-C. To help you factor MIS-C into the differential mix, we?ve annotated the clinical pathway originally published in our January issue to include MIS-C (see below). You won?t want to miss this clinically relevant flowchart ?hot off the press ? to ensure you?re fully up to date. 

Click here to download the flowchart!

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Last Updated on October 15, 2021

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