Main Article Content

Danyal Mehmood. Dr Zubair Ahmed Hamza Maqbool Dr Aniba Tabassum Dr Irslan hussain khan Bhu deesah phagwati. Dr Aqsa hassan Dr Afifa Munir Ahmad Kashif Lodhi


COVID-19 complications, Multisystem Inflammatory Syndrome in Children (MIS-C), pediatric populations, hyperinflammatory response, epidemiology, pathogenic mechanisms, public health, diagnosis, management.


The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has led to a range of clinical manifestations in both adults and children. Among the various complications related with COVID-19, Multisystem Inflammatory Syndrome in Children (MIS-C) has occurred as a distinct and concerning condition. MIS-C is considered by the hyperinflammatory response and multi-organ involvement, affecting pediatric populations who were previously asymptomatic or had mild COVID-19 symptoms. Understanding role of MIS-C within the spectrum of COVID-19 complications is crucial for healthcare providers, researchers, and policymakers.

Aim: This study aims to comprehensively investigate the clinical features, epidemiology, and potential mechanisms underlying MIS-C and its association with COVID-19. By analyzing available data, we seek to offer perceptions into character of MIS-C in broader context of COVID-19 complications, its impact on affected children, and the implications for public health approaches.

Methods: The study is conducted in Children hospital Lahore. A systematic review and meta-analysis were led to measure available literature on MIS-C in children with COVID-19. PubMed, Scopus, and other relevant databases were searched for researches published from beginning of the COVID-19 pandemic to present. Eligible studies were screened, and data were extracted and analyzed to identify common clinical presentations, demographic characteristics, and potential risk factors associated with MIS-C. Statistical analysis and qualitative synthesis were performed to derive meaningful insights.

Results: Our analysis revealed that MIS-C is very occasional but serious problem of COVID-19 in children, typically occurring a few weeks after the acute phase of the viral infection. Clinical manifestations of MIS-C comprise fever, gastrointestinal signs, cardiovascular abnormalities, and hyperinflammatory markers. Epidemiological data indicate that MIS-C is more prevalent among specific age groups and ethnic backgrounds. Possible pathogenic mechanisms involve an exaggerated immune response, potentially triggered by viral antigens. Timely recognition and appropriate management are essential to improve outcomes in affected children.

Conclusion: Multisystem Inflammatory Syndrome in Children (MIS-C) is an important entity within the spectrum of COVID-19 complications, affecting pediatric populations. It presents as a severe and systemic hyperinflammatory response and poses significant health risks to affected children. Early recognition, appropriate diagnosis, and management are crucial in mitigating the impact of MIS-C. Public health measures should consider the potential for MIS-C when planning COVID-19 mitigation strategies. Further research is required to fully recognize pathophysiology of MIS-C and to enhance targeted interventions to reduce the associated morbidity and mortality.

Abstract 38 | PDF Downloads 16


1. Kamath, V., Nivea, B., & Sheeba, R. (2023). Multisystem inflammatory syndrome in adults-In COVID-19. APIK Journal of Internal Medicine, 11(1), 2-6.
2. Encinosa, W., Moon, K., Figueroa, J., & Elias, Y. (2023). Complications, adverse drug events, high costs, and disparities in multisystem inflammatory syndrome in children vs COVID-19. JAMA Network Open, 6(1), e2244975-e2244975.
3. Andargie, T. E., Roznik, K., Redekar, N. R., Hill, T., Zhou, W., Apalara, Z., ... & Agbor-Enoh, S. (2023). Cell-free DNA reveals distinct pathology of multisystem inflammatory syndrome in children (MIS-C). The Journal of Clinical Investigation.
4. Molloy, E. J., Nakra, N., Gale, C., Dimitriades, V. R., & Lakshminrusimha, S. (2023). Multisystem inflammatory syndrome in children (MIS-C) and neonates (MIS-N) associated with COVID-19: optimizing definition and management. Pediatric research, 93(6), 1499-1508.
5. Hamad Saied, M., van der Griend, L., van Straalen, J. W., Wulffraat, N. M., Vastert, S., & Jansen, M. H. (2023). The protective effect of COVID-19 vaccines on developing multisystem inflammatory syndrome in children (MIS-C): a systematic literature review and meta-analysis. Pediatric Rheumatology, 21(1), 1-10.
6. Lee, P. I., & Hsueh, P. R. (2023). Multisystem inflammatory syndrome in children: A dysregulated autoimmune disorder following COVID-19. Journal of Microbiology, Immunology and Infection.
7. Balestrieri, E., Corinaldesi, E., Fabi, M., Cipriani, C., Giudice, M., Conti, A., ... & Sinibaldi-Vallebona, P. (2023). Preliminary Evidence of the Differential Expression of Human Endogenous Retroviruses in Kawasaki Disease and SARS-CoV-2-Associated Multisystem Inflammatory Syndrome in Children. International Journal of Molecular Sciences, 24(20), 15086.
8. Bose, P., Chacko, B., Arul, A. O., Vimala, L. R., Thangakunam, B., Varghese, G. M., ... & Peter, J. V. (2023). Delayed inflammatory pulmonary syndrome: A distinct clinical entity in the spectrum of inflammatory syndromes in COVID-19 infection?. World Journal of Critical Care Medicine, 12(4), 226.
9. Lee, S., Kim, D., Kim, B. J., Rhim, J. W., Lee, S. Y., & Jeong, D. C. (2023). Comparison of COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease shock syndrome: Case reports and literature review. Journal of Rheumatic Diseases, 30(4), 272-277.
10. Bentes, A. A., dos Santos Junior, W. R., Pessoa, N. L., Costa, T. A., Oliveira, G. F. G., Diniz, L. M. O., ... & Drumond, B. P. (2023). Neuro-COVID-19 With or Without the Multisystem Inflammatory Syndrome (MIS-C): A Single-Center Study: COVID-19: Neurologic Manifestations in Children. Journal of Molecular Neuroscience, 73(4-5), 250-258.
11. Meneghel, A., Masenello, V., Alfier, F., Giampetruzzi, S., Sembenini, C., Martini, G., ... & Zulian, F. (2023). Renal Involvement in Multisystem Inflammatory Syndrome in Children: Not Only Acute Kidney Injury. Children, 10(10), 1661.
12. Hernández-García, M., Roldan-Berengue, E., Guitart, C., Girona-Alarcón, M., Argüello, G., Pino, R., ... & Jordan, I. (2023). Multisystem inflammatory syndrome in children (MIS-C) and sepsis differentiation by a clinical and analytical score: MISSEP score. European Journal of Pediatrics, 1-10.
13. Amodio, D., Pascucci, G. R., Cotugno, N., Rossetti, C., Manno, E. C., Pighi, C., ... & Palma, P. (2023). Similarities and differences between myocarditis following COVID-19 mRNA vaccine and multiple inflammatory syndrome with cardiac involvement in children. Clinical Immunology, 255, 109751.
14. Feleszko, W., Okarska‐Napierała, M., Buddingh, E. P., Bloomfield, M., Sediva, A., Bautista‐Rodriguez, C., ... & Immunology Section and Working Group Infections of the EAACI. (2023). Pathogenesis, immunology, and immune‐targeted management of the multisystem inflammatory syndrome in children (MIS‐C) or pediatric inflammatory multisystem syndrome (PIMS): EAACI Position Paper. Pediatric Allergy and Immunology, 34(1), e13900.
15. Lin, J., Harahsheh, A. S., Raghuveer, G., Jain, S., Chouieter, N. F., Garrido-Garcia, L. M., ... & McCrindle, B. W. (2023). Emerging insights into the pathophysiology of multi-system inflammatory syndrome in children associated with COVID-19. Canadian Journal of Cardiology.
16. Edinoff, A. N., Alpaugh, E. S., Newgaard, O., Wajid, I., Klapper, R. J., Cornett, E. M., ... & Kaye, A. D. (2023). Tocilizumab for Severe COVID-19 Infection and Multisystem Inflammatory Syndrome in Adults and Children. Life, 13(4), 889.
17. Rosazza, C., Alagna, L., Bandera, A., Biffi, A., Ciciriello, F., Gramegna, A., ... & Colombo, C. (2023). Severity of SARS-CoV-2 infection in a hospital population: a clinical comparison across age groups. Italian Journal of Pediatrics, 49(1), 1-8.
18. Alam, A., Verma, N., Awasthi, S., Agarwal, D., Yadav, K. K., Gupta, P. K., ... & Puri, B. (2023). Clinical spectrum and prognostic markers of multi-system inflammatory syndrome in children hospitalised in Northern India. Clinical Epidemiology and Global Health, 23, 101357.
19. Sai, B. V. K., Kumar, H., Arun Babu, T., Chaitra, R., Satapathy, D., & Kalidoss, V. K. (2023). Clinical profile and outcome of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 infection: a single-center observational study from South India. Egyptian Pediatric Association Gazette, 71(1), 4.
20. Qamar, M. A., Afzal, S. S., Dhillon, R. A., Sajid, M. I., Sarfraz, Z., Sarfraz, A., ... & Zubairi, A. B. S. (2023). A global systematic review and meta-analysis on the emerging evidence on risk factors, clinical characteristics, and prognosis of multisystem inflammatory syndrome in adults (MIS-A). Annals of Medicine and Surgery, 85(9), 4463-4475.
21. Rudravaram, S., Agarwal, S., & Gupta, A. (2023). Anesthetic Considerations in Multisystem Inflammatory Syndrome in Children: A Case Series. Journal of PeriAnesthesia Nursing.
22. Netea, S. A., Biesbroek, G., van Stijn, D., Ijspeert, H., van der Made, C. I., Jansen, M. H., ... & Kuijpers, T. W. (2023). Transient anti-cytokine autoantibodies superimpose the hyperinflammatory response in Kawasaki disease and multisystem inflammatory syndrome in children: a comparative cohort study on correlates of disease. EBioMedicine, 95.
23. Fraser, R., Orta-Resendiz, A., Dockrell, D., Müller-Trutwin, M., & Mazein, A. (2023). Severe COVID-19 versus multisystem inflammatory syndrome: comparing two critical outcomes of SARS-CoV-2 infection. European Respiratory Review, 32(167).
24. Ehikhametalor, K., Deans-Minott, J., & Duncan, J. P. (2023). Multisystem inflammatory syndrome in adults (MIS-A) after COVID-19 infection and recent vaccination with recombinant adenoviral vector encoding the spike protein antigen of SARS-CoV-2 (ChAdOx1 nCoV-19, Vaxzevria). Journal of Intensive Care Medicine, 38(2), 232-237.
25. Kononowicz, J. E., Ali, M. F., Palko, W., Pyper, S., & Agasthya, N. (2023). Rapidly Progressing Autoimmune Hemolytic Anemia in a Pediatric Patient With COVID-19. Cureus, 15(9).
26. Korulmaz, A., & Kaya, S. (2023). A Case with Multiple Systemic Inflammatory Syndrome Presenting with Acute Appendicitis Symptoms. Center for Disease Control and Prevention (CDC), 4, 5.
27. Tastemel Ozturk, T., Düzova, A., Oygar, P. D., Baltu, D., Ozcilingir Hakverdi, P., Lacinel Gurlevik, S., ... & Topaloglu, R. (2023). Acute kidney injury in children with moderate-severe COVID-19 and multisystem inflammatory syndrome in children: a referral center experience. Pediatric Nephrology, 1-11.