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Pediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2

Covid-19 is generally a mild disease in children. Coinciding with the peak of the pandemic many children have been reported with a severe disease syndrome comprising fevers, shock with hyper-inflammation, and multiorgan dysfunction, now named pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2-(CoV-2). Although initially thought to be a spurt in cases of Kawasaki Disease (KD) the clinical manifestations differ from KD in being more common in older children with more severe derangements of inflammatory markers and cardiac dysfunction. Gastrointestinal symptoms are prominent. This is likely a postinfection hyper-inflammatory response as almost 90% test positive for antibodies against CoV-2 with significantly raised inflammatory markers and cytokine levels. Most children require cardiovascular and respiratory support and vasoactive therapy in intensive care units. Extracorporeal support is occasionally needed. Intravenous immunoglobulin, aspirin, and steroids are the cornerstones of therapy, though some refractory cases require immune-modulating agents. With adequate treatment, most have shown a favorable outcome.