Emerging Insights Into the Pathophysiology of Multisystem Inflammatory Syndrome Associated With COVID-19 in Children.
Document Type
Article
Publication Date
6-2023
Identifier
DOI: 10.1016/j.cjca.2023.01.002; PMCID: PMC9824951
Abstract
Multisystem inflammatory syndrome in children (MIS-C) has emerged as a rare delayed hyperinflammatory response to SARS-CoV-2 infection and causes severe morbidity in the pediatric age group. Although MIS-C shares many clinical similarities to Kawasaki disease (KD), important differences in epidemiologic, clinical, immunologic, and potentially genetic factors exist and suggest potential differences in pathophysiology and points to be explored and explained. Epidemiologic features include male predominance, peak age of 6 to12 years, and specific racial or ethnicity predilections. MIS-C is characterized by fever, prominent gastrointestinal symptoms, mucocutaneous manifestations, respiratory symptoms, and neurologic complaints, and patients often present with shock. Cardiac complications are frequent and include ventricular dysfunction, valvular regurgitation, pericardial effusion, coronary artery dilation and aneurysms, conduction abnormalities, and arrhythmias. Emerging evidence regarding potential immunologic mechanisms suggest that an exaggerated T-cell response to a superantigen on the SARS-CoV-2 spike glycoprotein-as well as the formation of autoantibodies against cardiovascular, gastrointestinal, and endothelial antigens-are major contributors to the inflammatory milieu of MIS-C. Further studies are needed to determine both shared and distinct immunologic pathway(s) that underlie the pathogenesis of MIS-C vs both acute SARS-CoV-2 infection and KD. There is evidence to suggest that the rare risk of more benign mRNA vaccine-associated myopericarditis is outweighed by a reduced risk of more severe MIS-C. In the current review, we synthesize the published literature to describe associated factors and potential mechanisms regarding an increased risk of MIS-C and cardiac complications, provide insights into the underlying immunologic pathophysiology, and define similarities and differences with KD.
Journal Title
The Canadian journal of cardiology
Volume
39
Issue
6
First Page
793
Last Page
802
MeSH Keywords
Humans; Child; Male; Female; COVID-19; SARS-CoV-2; Systemic Inflammatory Response Syndrome; Mucocutaneous Lymph Node Syndrome; Coronary Aneurysm; Coronary Vessels
Keywords
COVID-19; SARS-CoV-2; Systemic Inflammatory Response Syndrome; Mucocutaneous Lymph Node Syndrome; Coronary Aneurysm; Coronary Vessels
Recommended Citation
Lin J, Harahsheh AS, Raghuveer G, et al. Emerging Insights Into the Pathophysiology of Multisystem Inflammatory Syndrome Associated With COVID-19 in Children. Can J Cardiol. 2023;39(6):793-802. doi:10.1016/j.cjca.2023.01.002
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