Multisystem Inflammatory Syndrome in Children (MIS-C), a Post-viral Myocarditis and Systemic Vasculitis-A Critical Review of Its Pathogenesis and Treatment

Jeremy C McMurray; Joseph W May; Madeleine W Cunningham; Olcay Y Jones

doi:10.3389/fped.2020.626182

Multisystem Inflammatory Syndrome in Children (MIS-C), a Post-viral Myocarditis and Systemic Vasculitis-A Critical Review of Its Pathogenesis and Treatment

Front Pediatr. 2020 Dec 16:8:626182. doi: 10.3389/fped.2020.626182. eCollection 2020.

Authors

Jeremy C McMurray¹, Joseph W May^{1

2

3}, Madeleine W Cunningham⁴, Olcay Y Jones^{1

3

5}

Affiliations

¹ Department of Pediatrics, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, United States.
² Division of Pediatric Cardiology, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, United States.
³ Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
⁴ Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
⁵ Division of Pediatric Rheumatology, WRNMMC, Bethesda, MD, United States.

Abstract

MIS-C is a newly defined post-viral myocarditis and inflammatory vasculopathy of children following COVID-19 infection. This review summarizes the literature on diagnosis, parameters of disease severity, and current treatment regimens. The clinical perspective was analyzed in light of potential immunopathogenesis and compared to other post-infectious and inflammatory illnesses of children affecting the heart. In this paradigm, the evidence supports the importance of endothelial injury and activation of the IL-1 pathway as a common determinant among MIS-C, Kawasaki disease, and Acute Rheumatic fever.

Keywords: IL-1 (interleukin-1); MIS-C; coronary artery aneurysm; myocarditis; vasculitis.

Publication types

Review