Note: Note: Guidance is based on expert consensus. Subspecialty consultation for individualized recommendations for suspected cases is strongly recommended. The Version 3 Guidlelines also highlight that “…at this time, given the high prevalence of COVID-19 in certain communities, seropositvity to SARS-CoV-2 (nucleocapsid or spike protein) may no longer adequately distinguish between MIS-C and other overlapping syndromes, although a negative antibody test should prompt consideration of alternative diagnoses…”.
*Figure 1 below used with Copyright License.
Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 and Hyperinflammation in COVID-19 - PDF
Dermatologic: Take photo of rash/upload to Epic, Consider the following tests (HSV, VZV, enterovirus PCR); Consider alternative rheumatologic diagnoses that present with fever and rash – Systemic JIA, Lupus, Kawasaki disease. GI: Consider GI pathogen PCR panel; C difficile toxin PCR; Stool culture; Neurologic: Head imaging – consider if with focal neurologic deficit, altered mental status, seizure, severe headache with meningeal signs. If no contraindications, perform lumbar puncture (cell count, protein, glucose, culture, meningoencephalitis panel) AND CONSULT NEUROLOGY.
Contributors: Robert Santos, MD, April Palmer, MD, Charlotte Hobbs, MD (Pediatric Infectious Disease); Anita Dhanrajani, MD, (Pediatric Rheumatology); Catherine Gordon, MD (Pediatric Hematology/Oncology); Divya Shakti, MD and Bill Moskowitz, MD (Pediatric Cardiology); Claire Gilliam, MD (Pediatric Hospitalist); Jenny Hong (PICU), Jeanie Craft (Pediatric Infectious Disease, MIS-C Clinic Coordinator).
LAST GUIDANCE UPDATE: JANUARY 2022
Suggested readings and additional online resources for specialists caring for children with MIS-C:
American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV‐2 and Hyperinflammation in Pediatric COVID‐19: Version 3.Available at https://www.rheumatology.org/Portals/0/Files/ACR-COVID-19-Clinical-Guidance-Summary-MIS-C-Hyperinflammation.pdf
The Children’s Hospital of Philadelphia (CHOP) clinical pathway for evaluation of possible MIS-C, Kawasaki pathway, suspected MIS-C with shock, and sepsis pathway:https://www.chop.edu/clinical-pathway/multisystem-inflammatory-syndrome-mis-c-clinical-pathway
Centers for Disease Control and Prevention. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19).Available at: https://emergency.cdc.gov/han/2020/han00432.asp
American Academy of Pediatrics, COVID-19 Interim Guidance: Return to Sports and Physical Activity.Available at: https://www.aap.org/en/pages/2019-novel-coronaviruscovid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/
Centers for Disease Control and Prevention. Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States.Available at: https://www.cdc.gov/vaccines/covid19/clinical-considerations/covid-19-vaccines-us.html#CoV-19-vaccination