Comparison of post-covid-19 multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease

Abstract

Post-covid-19 multisystem inflammatory syndrome in children (MIS-C) is a novel, life-threatening hyperinflammatory condition that develops in children a few weeks after infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Its clinical features and laboratory characteristics are similar to those of Kawasaki disease (KD), KD shock syndrome, and toxic shock syndrome that present diagnostic and therapeutic challenges to the physician. However, this new disorder has some distinct clinical features and laboratory characteristics. MIS-C presents with a greater variety of signs and symptoms and is more often characterized by gastrointestinal and neurologic symptoms. MIS-C more typically presents with ventricular dysfunction and shock (more than 50% in MIS-C versus 5–10% in KD). The development of coronary artery aneurysms in both disorders may increase diagnostic uncertainty. Children with MIS-C have lower absolute lymphocyte and platelet counts, higher ferritin and D-dimer levels, and a higher likelihood of having elevated troponin or ProBNP levels. This review will compare and contrast MIS-C and KD in terms of clinical symptoms, blood markers, cardiac manifestations, diagnostic criteria, and treatment.