Hyperinflammatory syndrome in children related to Covid-19

The coronavirus disease 2019 (Covid-19) has been implicated in a Cytokine Release Syndrome (CRS) in adults. Initial reports of Covid-19 suggested a milder disease course and better prognosis in children. However, a new inflammatory syndrome, reminiscent of Kawasaki Disease (KD) is associated with covid-19 in a proportion of children. This has been variously referred to as Kawasaki-like disease, multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome, temporally associated with SARS-CoV2 (PIMS-TS). Similar to KD, these patients have frequent cardiac involvement and are responsive to steroids and intravenous immunoglobulins (IVIG). But there are important distinctions in that, they are older, often have gastrointestinal manifestations, and more profound lymphopenia, and acute phase response. In this review, we underline the important takeaways from various published case series, and describe clinical characteristics, speculated pathogenetic mechanisms, implications for treatment and future directions for this novel syndrome.