MIS-C is a rare condition triggered by SARS-CoV-2 infection that causes widespread inflammation throughout the body. Many children with MIS-C were asymptomatic or had mild COVID symptoms at first but weeks later developed a variety of nonrespiratory symptoms including abdominal pain, skin rashes, heart abnormalities, and, in some cases, vasodilatory shock (extremely low blood pressure).
Some of the first MIS-C cases in the United States were seen in spring 2020 by Columbia pediatricians at NewYork-Presbyterian Morgan Stanley Children’s Hospital.
“It was both challenging and scary, because we didn’t know how these patients would do long term, especially in terms of cardiac and immunologic abnormalities, which were the most prominent issues at the time,” says Dr. Farooqi, who is also an assistant professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons.
When first admitted to the hospital, most of the 45 children (median age 9 years old) in the study were critically ill and required intensive care. Nearly 80% of the children had some type of cardiac dysfunction, and almost half had moderate to severe cardiac abnormalities, including decreased ability of the heart to pump properly, coronary artery dilation, and leaking heart valves. Two-thirds of the children experienced a temporary decrease in the number of white blood cells during their hospital stay. The majority had an increase in inflammatory markers, and more than half also had elevated cardiac-specific markers indicating heart injury.
To ease the inflammatory response, doctors treated the children with steroids, and most received intravenous immunoglobulin and immunomodulators. One-third received respiratory support, though none required ECMO (an external life-support machine). More than half received therapies to increase and maintain blood pressure.
“These kids were quite sick, but at our hospital, where we began using steroids and other treatments routinely for MIS-C, most of the patients responded rapidly and were discharged by about five days,” Dr. Farooqi says.