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# Multisystem inflammatory syndrome in children (MIS-C)

A rare, serious inflammation of many organs, especially the heart, that appears weeks after a COVID-19 infection in children. It needs hospital care.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Right coronary artery](https://durgical.com/en/anatomy/right-coronary-artery/)
- [Pericardium](https://durgical.com/en/anatomy/pericardium/)
- [Ascending aorta](https://durgical.com/en/anatomy/ascending-aorta/)

## Why it happens

- [Systemic effects of inflammation: fever, acute-phase proteins, leukocytosis, sepsis](https://durgical.com/en/general-pathology/systemic-effects-of-inflammation-fever-acute-phase-proteins-leukocytosis-sepsis/)
- [Shock: types, stages and the organs it damages](https://durgical.com/en/general-pathology/shock-types-stages-and-the-organs-it-damages/)

## What it is

A post-infectious hyperinflammatory syndrome that follows SARS-CoV-2 infection by about 2–6 weeks. Fever and raised inflammatory markers are joined by involvement of two or more organ systems, most often the heart, gut, [skin](https://durgical.com/en/anatomy/skin/) and mucosae, and it can cause shock.

## Who gets it

It peaked about a month after each COVID-19 wave and became much rarer with population immunity and vaccination; cases still occur. Latin American hospital series, including from Colombia, reported a high share of children needing intensive care; many had had mild or no COVID-19 symptoms.

## Causes

- Recent SARS-CoV-2 infection or exposure (often 2–6 weeks earlier)
- A dysregulated immune response rather than direct viral damage
- Many children had an asymptomatic or mild initial infection

## Risk factors

- School age (median around 8–9 years)
- No COVID-19 vaccination
- Periods of high community transmission of SARS-CoV-2

## Pathophysiology

Weeks after the virus is cleared, a cytokine storm with endothelial injury and a hypercoagulable state develops. Inflammation of the myocardium causes ventricular dysfunction and vasodilatory or cardiogenic shock, and inflamed coronary arteries can dilate or form aneurysms, as in Kawasaki disease. The gut, [kidneys](https://durgical.com/en/anatomy/kidney/), skin, eyes and brain may also be involved.

## Classification

- MIS-C without shock
- MIS-C with shock or ventricular dysfunction
- MIS-C with Kawasaki-like features (with or without coronary changes)

## Symptoms and signs

- Persistent fever
- Abdominal pain, vomiting and diarrhoea, sometimes mimicking appendicitis
- Rash, non-purulent conjunctivitis, red cracked lips and swollen hands or feet
- Fatigue, irritability, headache or confusion
- Low blood pressure, cold extremities and fast breathing in severe cases

## Red flags

- Hypotension, delayed capillary refill or altered consciousness (shock)
- [Chest](https://durgical.com/en/anatomy/region/chest/) pain, arrhythmia or signs of heart failure
- Breathing difficulty
- Severe abdominal pain
- Low urine output

## Diagnosis

**Clinical**
Fever with multisystem involvement in a child with recent SARS-CoV-2 infection or exposure, after excluding other causes; case definitions from public health agencies guide reporting.

**Tests**
High CRP, ESR, ferritin and D-dimer; lymphopenia, thrombocytopenia, low albumin; raised troponin and BNP; SARS-CoV-2 serology or PCR; blood cultures and tests for other infections; ECG.

**Imaging**
Echocardiography for ventricular function and coronary arteries, repeated during follow-up; abdominal ultrasound if surgical [abdomen](https://durgical.com/en/anatomy/region/abdomen/) is considered.

## Differential diagnosis

- Kawasaki disease
- Toxic shock syndrome and bacterial sepsis
- Viral myocarditis
- Rickettsial infections and dengue
- Acute appendicitis
- Macrophage activation syndrome

## Goal of treatment

Stop the inflammation quickly, support the circulation and protect the coronary arteries and heart function.

## Treatment

**Acute**
Hospital admission, often to intensive care, with fluid resuscitation used cautiously, inotropes or vasopressors for shock, and respiratory support as needed.

**Medical**
Immunomodulation: intravenous immunoglobulin and systemic glucocorticoids are first line; biologic agents such as anakinra are used for refractory cases.

**Medical**
Low-dose aspirin is prescribed by the medical team for coronary involvement or thrombosis risk, and anticoagulants in selected patients; empirical antibiotics until cultures exclude sepsis.

**Follow-up**
Nursing: continuous cardiorespiratory monitoring, fluid balance and urine output, daily inflammatory markers. After discharge, cardiology follow-up with repeat echocardiograms and restriction of strenuous exercise until cleared.

## Complications

- Shock and multi-organ failure
- Left ventricular dysfunction and myocarditis
- Coronary artery dilation or aneurysm
- Arrhythmias
- Thrombosis
- Acute kidney injury

## Prognosis

With prompt treatment most children recover fully; heart function and inflammation usually normalise within 6 months. Death is uncommon. Some children have fatigue or attention and mood problems that mostly resolve within 2 years.

## Prevention

- COVID-19 vaccination lowers the risk of MIS-C
- Measures that reduce SARS-CoV-2 transmission

## Test yourself

Think of the answer, then tap the question to see it.

## When does MIS-C typically appear relative to SARS-CoV-2 infection?

About 2–6 weeks after the infection, often after a mild or silent case.

## Which classic paediatric vasculitis does MIS-C resemble?

Kawasaki disease, including possible coronary artery aneurysms.

## What are the first-line immunomodulating treatments?

Intravenous immunoglobulin and systemic glucocorticoids.

## Which imaging test is essential at diagnosis and follow-up?

Echocardiography, to assess ventricular function and the coronary arteries.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/multisystem-inflammatory-syndrome-in-children/)

## Related conditions

- [COVID-19](https://durgical.com/en/conditions/covid-19/)
- [Kawasaki disease](https://durgical.com/en/conditions/kawasaki-disease/)
- [Myocarditis](https://durgical.com/en/conditions/myocarditis/)
- [Toxic shock syndrome](https://durgical.com/en/conditions/toxic-shock-syndrome/)
- [Sepsis and septic shock](https://durgical.com/en/conditions/sepsis-and-septic-shock/)
- [Acute pericarditis](https://durgical.com/en/conditions/acute-pericarditis/)
- [Heart failure](https://durgical.com/en/conditions/heart-failure/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [About MIS](https://www.cdc.gov/mis/about/index.html) (Centers for Disease Control and Prevention (CDC), 2025); [Clinical Treatment of Multisystem Inflammatory Syndrome in Children](https://www.cdc.gov/mis/hcp/clinical-care-treatment/index.html) (Centers for Disease Control and Prevention (CDC), 2026).

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Source: https://durgical.com/en/conditions/multisystem-inflammatory-syndrome-in-children/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/multisystem-inflammatory-syndrome-in-children/