Published: 2021-11-23

Clinical profile and outcome of multisystem inflammatory syndrome in children in a tertiary care centre of North Kerala: a prospective study

Naveena Sajeevan, Mohammed Manakkatt T. P., Kavitha Pavithran, Urmila Muraleekrishnan K. V.


Multisystem inflammatory syndrome in children (MIS-C) is a newly emerged disease following the outbreak of COVID-19. The nomenclature is given by WHO. Similar condition is named as paediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV2 virus (PIMS-TS), by RCPCH. To study the clinical profile and outcome of MIS-C in 2 months to 18 years old. The 25 children, admitted in PICU and pediatrics ward were included in the study. The 79% required PICU admission and two required mechanical ventilation. One child expired. Children presented with conjunctival congestion (53%), diarrhoea (47%), cervical lymphadenopathy (37%), shock (31.5%), vomiting (36.8%), rashes (36.8%), mucosal erythema (36.8%), cough (10.5%) and headache (10.5%). Inflammatory markers were elevated in all the children. On initial echocardiography, 4 children (21%) had LV dysfunction with LVEF <50%. Six children (31.5%) were treated with IVIG and IV methylprednisolone, changed to oral prednisolone after 3 days and continued for 2 weeks. Three children (18%) were treated with IVIG and oral prednisolone. Two children (12%) were treated with IVIG alone. Eight children (47%) were treated with methylprednisolone alone. The median duration of hospitalisation was 5 days. 18 children (94.7%) were discharged to home within one week of admission. One 8 months old baby presented with shock, succumbed to death in spite of giving IV methyl prednisolone and IVIG. In our study we observed that early diagnosis and treatment with IVIG or steroids offers good outcome for the condition. Of the 19 children studied, 17 children were discharged within one week.


Multisystem inflammatory syndrome, Intravenous immunoglobulin, Cytokine storm

Full Text:



World Health Organization. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19: Scientific Brief 2020. WHO. 2020;10:1-9. Available at: Accessed on 15 May 2021.

Royal College of Paediatrics and Child Health. Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS)-guidance for clinicians. Royal College of Paediatrics and Child Health. 2020. Available at: 15 May 2021.

Kaushik S, Aydin SI, Derespina KR, Bansal PB, Kowalsky S, Trachtman R et al. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection: A Multi-institutional Study from New York City. J pediatr (Rio J). 2020;

Jain S, Sen S, Lakshmivenkateshiah S, Bobhate P, Venkatesh S, Udani S et al. Multisystem Inflammatory Syndrome in Children With COVID-19 in Mumbai, India. Indian Pediatr. 2020;57(11):1015-9.

Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395:1607-8.

Ramcharan T, Nolan O, Lai CY, Prabhu N, Krishnamurthy R, Richter AG et al. Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. Pediatr Cardiol. 2020;41(7):1391-401.

Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J et al. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med. 2020;383(4):347-58.

Dionne A, Mah DY, Son MBF, Lee PY, Henderson L, Baker AL et al. Atrioventricular Block in Children with Multisystem Inflammatory Syndrome. Pediatrics. 2020;146:5.

Domico M, McCanta AC, Hunt JL, Ashouri N, Nugent D, Kelly RB. High-grade heart block requiring transvenous pacing associated with multisystem inflammatory syndrome in children during the COVID-19 pandemic. Hear Case Reports. 2020;6(11):811-4.

Belhadjer Z, Méot M, Bajolle F, Khraiche D, Legendre A, Abakka S et al. Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic. Circulation. 2020;142(5):429-36.

Torres JP, Izquierdo G, Acuña M, Pavez D, Reyes F, Fritis A et al. Multisystem inflammatory syndrome in children (MIS-C): Report of the clinical and epidemiological characteristics of cases in Santiago de Chile during the SARS-CoV-2 pandemic. Int J Infect Dis. 2020;100:75-81.

Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020;383(4):334-46.

Correction to: Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals from the American Heart Association. Circulation. 2019;140:E181-4.

Gottlieb M, Long B, Koyfman A. The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature. J Emerg Med. 2018;54(6):807-14.

Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K et al. Multisystem inflammatory syndrome in children: A systematic review. EClin Med. 2020;26.

Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P et al. Clinical Characteristics of 58 Children with a Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2. J Am Med Assoc. 2020;324(3):259-69.

Chiotos K, Bassiri H, Behrens EM, Blatz AM, Chang J, Diorio C et al. Multisystem inflammatory syndrome in children during the coronavirus 2019 pandemic: A case series. J Pediatric Infect Dis Soc. 2020;9(3):393-8.

Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, Abrams J et al. COVID-19-Associated Multisystem Inflammatory Syndrome in Children-United States, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1074-80.

Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395(10239):1771-8.