Multi-System Inflammatory Syndrome In Children: A Pediatric Hospitalist’s Conversation

Them: “I have never heard of this.”

Me: “That’s OK, let me explain what is going on. Your child has a condition called multi-system inflammatory syndrome in children, which we call MIS-C. We see this condition after a COVID infection where the whole body becomes inflamed, causing fevers. You get inflammation in the small blood vessels of your eyes and skin, which is why your son has red eyes and a rash. You get inflammation in your intestines, which is why he has abdominal pain and vomiting. You get it in your internal organs, and we can see that as kidney and liver injury on your son’s lab test. You get it in the brain, which is why your son is so sleepy and not acting like his normal self.

And the most worrisome is when you get inflammation in your heart. This is why your son has low blood pressure right now because his heart is not functioning properly, meaning it isn’t strong enough to pump the blood out to the rest of the body. Since learning about MIS-C, the good news is that we have found some therapies that work to reduce this inflammation. The one we use first here is IVIG, which stands for intravenous immune globulin. This is considered a blood product because it is taken from a pool of people who have donated blood, and then we take their antibodies and will give them to your son to try and reduce the inflammation that is happening in his body.

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This medication does have risks. It can cause a fever, lower his blood pressure, have a severe allergic reaction to it, and rarely cause aseptic meningitis or irritation around the brain. We can also use steroids to help reduce inflammation and may need to use an anticoagulant or blood thinner medication to ensure he doesn’t develop blood clots. I will do my best to support his blood pressure with fluids, but it’s possible there will come a time when he will need additional medications to support his blood pressure and to help his heart function, and if that happens, we will have to transfer him to the ICU. If he can stay on the floor, we will consult the cardiology, hematology, and infectious disease doctors to help care for him. What questions to do have so far?”

Them: Blank stare

Me: “Don’t worry, you are in the right place, and we will take great care of your son. I also understand that you have other kids at home eligible but unvaccinated for COIVD. We are finding the vaccines to be incredibly safe for kids and about 90 percent effective in protecting them from MIS-C. As a pediatrician and mom, this diagnosis is very scary and the reason I chose to get my kids vaccinated. Please consider it for your other kiddos.”

Repeat.

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