The first time Shreyasi Ghosh from Mumbai heard of multisystem inflammatory syndrome in children (MIS-C) was when she took her ailing son to the hospital. She shares that her son, Aahaan, who is now four, was born in February 2020, during the initial days of the pandemic. Ghosh shares that she had tried her best to safeguard her baby from the novel Coronavirus. She was also very keen on adhering to the child’s vaccination schedule, but he had developed a high-grade fever just a day prior to his vaccination, which remained constant for three days. 

“At the same time, he had red rashes on his arms, which we initially ignored as mosquito bites. But these patches spread to his chin and back. His eyes turned red, while his stool was green. Moreover, his sudden inactivity scared my husband and me.” The distraught couple rushed their newborn to the hospital for clinical examination.

Dr Bijal Srivastava, pediatrician, Dr LH Hiranandani Hospital, Mumbai who was treating Aahan said that in 2020, while the world was trying to understand and manage COVID-19, it came as a relief that children were at lesser risk of contracting the virus. “But, global guidelines had also prepared medical experts for a rare condition associated with COVID-19 that could affect kids, known as multisystem inflammatory syndrome in children,” she added.

Symptoms of multisystem inflammatory syndrome 

At the hospital, Aahan was tested for SARS-CoV-2 (the virus that causes COVID-19) and Kawasaki disease, an illness that causes inflammation and redness in the blood vessels to understand the source of the infection. After ruling out these conditions, Dr Srivastava recalled testing him for multisystem inflammatory syndrome in children associated with COVID-19. While most children contracted mild infections during the pandemic, some did have this post-Covid sequelae, which came as a shocker for parents of the children affected. 

MIS-C associated with COVID-19 typically develops in kids who had COVID-19 three to four weeks earlier, explains Dr Srivastava. Ghosh also recalls that a month prior to Aahaan’s fever, he went to the hospital to be vaccinated. “It had a COVID ward, too. Aahaan may have contracted COVID-19 and had an asymptomatic illness,” Ghosh shared.

According to the Centers for Disease Control and Prevention, US, MIS-C associated with COVID-19 is suspected when a child has a persistent fever and one or more of the following symptoms:

• Stomach pain
• Bloodshot eyes
• Diarrhea
• Dizziness or lightheadedness (signs of low blood pressure)
• Rashes on the skin
• Vomiting

Aahaan had two of the above-mentioned symptoms and was noticeably inactive. Dr Srivastava also explained that as the name suggests, multisystem inflammatory syndrome in children leads to swelling in different parts of the body, including the heart, lungs, kidneys, brain, skin, eyes, and gastrointestinal tract, and causes a shock-like response in the child; hence, immediate treatment is crucial. Unlike Kawasaki disease, which has similar symptoms, MIS-C can spread quickly and affect different parts of the body.

MIS-C treatment for an infant

A 2021 meta-analysis from US researchers indicated that the average age of children who contracted MIS-C associated with COVID-19 was 9.3 years. Treatment for multisystem inflammatory syndrome in children associated with COVID-19 is a blend of curative and supportive treatment, says Dr Srivastava. Most of them were given intravenous immunoglobulin (IVIG), steroids and anti-inflammatory medicines.

“Once we suspected that Aahaan had multisystem inflammatory syndrome in children associated with COVID-19, we knew we had to start treatment immediately. This was one of the nascent cases in our hospital,” Dr Srivastava recalled. Aahaan’s blood test reports indicated a high level of inflammation. Doctors recommended tests such as a chest x-ray, heart ultrasound (echocardiogram) and abdominal ultrasound to check if the organs were swollen, his mother added. His first line of treatment comprised IVIG. 

Additionally, Aahaan was administered supportive treatment — IV fluids and medication and rehydration fluids — to regulate blood pressure and urine output. He was also provided oxygen support to overcome the shock. He was discharged from the hospital after two days.

The road to recovery

Aahaan’s parents remained tense after he was hospitalized until they saw the medication working for their little one. As the red patches on his body reduced and his eyes started looking more normal, the parents could breathe again. 

While the little one was discharged from the hospital within two days, his medication continued for about a month. This included anti-inflammatory and blood-thinning medicines. “About 10 days after he was discharged, we visited a pediatric cardiologist to check his heart health. When the echocardiogram indicated no heart inflammation, we could finally breathe easy,” recalled Ghosh. Aahaan then went on to hit his milestones on time — or even earlier, in some cases. 

Should parents be concerned about multisystem inflammatory syndrome in children?

Post COVID-19, parents can be free from the worry of MIS-C associated with COVID-19. However, Kawasaki disease also has many similar symptoms, including inflammation of the various organs. Experts advise parents to exercise caution regarding this condition.