News | Coronavirus (COVID-19) | September 14, 2020

Case Study Describes One of the First U.S. Cases of MIS-C

Finding of multisystem inflammatory syndrome in children associated with COVID-19 helped create new clinical pathway guidelines to quickly identify and treat cases

Exantham on abdomen and back of a pediatric patient at Nemours Children’s Health System in Delaware who presented with mysterious symptoms in what would later be identified as one of the first cases of multisystem inflammatory syndrome in children (MIS-C) in the United States.

Exantham on abdomen and back of a pediatric patient at Nemours Children’s Health System in Delaware who presented with mysterious symptoms in what would later be identified as one of the first cases of multisystem inflammatory syndrome in children (MIS-C) in the United States. Find more images

September 14, 2020 – At the height of the COVID-19 (SAR-CoV-2) pandemic in April, a 14-year-old boy was admitted to the emergency department at Nemours Children’s Health System in Delaware with mysterious symptoms in what would later be identified as one of the first cases of multisystem inflammatory syndrome in children (MIS-C) in the United States. His care and retrospective diagnosis have been published in Progress in Pediatric Cardiology as a timely case study linking COVID-19 to the highly dangerous syndrome which is rare in children and causes inflammation of the heart, lungs and other vital organs.[1] 

Access the full article

“There are lessons to be learned from this case, the most critical being to maintain your suspicion if there are several plausible diagnoses,” said Deepika Thacker, M.D., senior author of the paper and pediatric cardiologist with Nemours Children’s Health System. “This allowed us to remain vigilant and adapt treatment as we went, based on the signals and symptoms we were seeing.”

Prior to reports from Europe about similar cases in children, the patient presented to the emergency department with a four-day history of fever, fatigue and abdominal pain. He initially tested negative for COVID-19 and was admitted to the general pediatric ward. But his condition quickly deteriorated, with severe diarrhea, increasingly high fever and a quickly spreading rash that further escalated to chest pain, fluid in the lungs and decreasing heart function. 

The seemingly unconnected presentation of symptoms made several diagnoses appear possible. While being treated in the cardiac intensive care unit, the patient had to be intubated and placed on mechanical ventilation. During his 12-day hospital stay, he was treated with penicillin, ceftriaxone, epinephrine, phenylephrine, milrinone, intravenous immune globulins, and high-dose aspirin to cover the wide variety of possible conditions. Only after discharge, an antibody test showed he had had COVID-19. 

Based on the team’s experience with this patient and others, as well as data from other centers, Nemours’ physicians developed a clinical pathway for early recognition and treatment of MIS-C to speed the diagnosis and care of children with this new presentation of COVID-19.  

“In the three months since this patient was in critical care, we have learned so much about diagnosing and treating this novel presentation of COVID-19 in children,” said Thacker. “This information-sharing has undoubtedly saved lives.”

This first patient recovered, as have all 15 patients treated with MIS-C at Nemours Children’s Health System in Delaware.  Moving forward, the cardiology team will continue to follow up with patients who have experienced MIS-C for at least one year to understand the long-term impact of this acute condition. 

VIDEO: Overview of Multisystem Inflammatory Syndrome in Children (MIS-C) in COVID-19 Exposed Children — Interview with Deepika Thacker, M.D.

 

MIS-C pediatric patient echocardiogram

Echocardiogram showing trivial dilation of left coronary artery. AoV: aortic valve; LMCA: left main coronary artery. 

CDC Now Reports 800 U.S. Children Diagnosed With MIC-C

The Centers for Disease Control and Prevention (CDC) reported as of Sept. 10, 2020, there have been 792 confirmed cases in the United States of the rare MIS-C condition in children that is linked to COVID-19.

The agency also reported there have been 16 deaths reported from the MIS-C cases reported in 42 states, New York City and Washington, D.C., as of Sept. 3. Nearly all cases of MIS-C occurred in children who tested positive for the new coronavirus, while the remainder were in children who were around a person with COVID-19.

The CDC report also gave the following statistics:

   • Most cases are in children between the ages of 1 and 14 years, with an average age of 8 years.
   • Cases have occurred in children from <1 year old to 20 years old.
   • More than 70% of reported cases have occurred in children who are Hispanic/Latino (276 cases) or non-Hispanic Black (230 cases).
   • 99% of cases (783) tested positive for SARS CoV-2, the virus that causes COVID-19. The remaining 1% were around someone with COVID-19.
   • Most children developed MIS-C 2-4 weeks after infection with SARS-CoV-2.
   • Slightly more than half (54%) of reported cases were male.

Find additional CDC statistics on U.S. MIS-C cases

 

Additional MIS-C Information and Guidance on Testing and Treatment:

Centers for Disease Control and Prevention Health Alert Network — Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19)

World Health Organization (WHO) Scientific Brief — Multisystem Inflammatory Syndrome in Children and Adolescents With COVID-19

Royal College of Paediatrics and Child Health — Guidance: paediatric multisystem inflammatory syndrome temporally associated with COVID-19

 

Related Content on MIS-C:

Kawasaki-like Inflammatory Disease Affects Children With COVID-19

VIDEO: Overview of Multisystem Inflammatory Syndrome in Children (MIS-C) in COVID-19 Exposed Children — Interview with Deepika Thacker, M.D.

NIH-funded Project Wants to Identify Children at Risk for MIS-C From COVID-19

New Study Looks at Post-COVID-19 Emerging Disease in Children

Cardiac MRI Aids Evaluation of Children With Multisystem Inflammatory Syndrome (MIS-C) Associated With COVID-19

The Cardiovascular Impact of COVID-19

 

Related Content

The Mesuron Inc. Avalon-H90 uses magnetometers to detect myocarditis in patients without any physical contact. It uses ventricular repolarization dynamics analysis software to look for abnormalities. The vendor said it is more specific than using ECG. It detects the multidimensional dynamics of the electrical activity caused by differences in functions of electrical action potential of normal heart tissues and abnormal ones with hypoxia.

The Mesuron Inc. Avalon-H90 uses magnetometers to detect myocarditis in patients without any physical contact. It uses ventricular repolarization dynamics analysis software to look for abnormalities. The vendor said it is more specific than using ECG. It detects the multidimensional dynamics of the electrical activity caused by differences in functions of electrical action potential of normal heart tissues and abnormal ones with hypoxia. 

News | Cardiac Diagnostics | October 06, 2020
October 6, 2020 — A new technology being developed by U.S.-based Mesuron Inc.
With the advent and optimization of nuclear scintigraphy protocols using bone-avid radiotracers, cardiac amyloidosis caused by transthyretin protein (ATTR) can now be diagnosed noninvasively without a costly tissue biopsy. The radiotracer 99mTc-pyrophosphate (99mTc-PYP) binds to deposited ATTR amyloid fibrils in the myocardium and can be visualized using planar and SPECT imaging. Amyloidosis Patient Registry  #Amyloidosis

With the advent and optimization of nuclear scintigraphy protocols using bone-avid radiotracers, cardiac amyloidosis caused by transthyretin protein (ATTR) can now be diagnosed noninvasively without a tissue biopsy. The radiotracer 99mTc-pyrophosphate (99mTc-PYP) binds to deposited ATTR amyloid fibrils in the myocardium and can be visualized using planar and SPECT imaging. This is Figure 2, showing how SPECT imaging allows the reader to distinguish between blood pool activity (ventricular cavity, etc) and myocardial activity and identify regional myocardial differences in radiotracer uptake.

News | Cardiac Diagnostics | March 05, 2020
March 5, 2020 — More than 300 patients have joined the Amyloidosis Patient Registry and it is now available to the en
heart disease image
News | Cardiac Diagnostics | December 18, 2019
December 18, 2019 — In their latest report, “...
FDA Warns Troponin Tests Impacted by Biotin Dietary Supplement
Feature | Cardiac Diagnostics | November 05, 2019 | Dave Fornell, Editor
November 5, 2019 — The U.S.
Videos | Cardiac Diagnostics | October 29, 2019
Doctor Clyde Yancy was a keynote speaker and said doctors need to check their assumptions about patients at the door...
79-year-old Tony Marovic had a right carotid endarterectomy shortly after discovering a 95 percent blockage of his carotid artery at a health and wellness screening event

79-year-old Tony Marovic had a right carotid endarterectomy shortly after discovering a 95 percent blockage of his carotid artery at a health and wellness screening event. Image courtesy of University Hospitals.

News | Cardiac Diagnostics | October 16, 2019
Health and wellness screenings are more than just nice events for the community – they can save lives. A Mentor, Ohio,...
Pesticide Exposure May Increase Heart Disease and Stroke Risk

Image courtesy of zefe wu from Pixabay

News | Cardiac Diagnostics | October 15, 2019
On-the-job exposure to high levels of pesticides raised the risk of heart disease and stroke in a generally healthy...
World Heart Federation Launches Global Roadmap on Cardiovascular Disease Prevention Among Diabetics
News | Cardiac Diagnostics | September 04, 2019
At the European Society of Cardiology (ESC) Congress 2019 together with the World Congress of Cardiology, the World...