Table 1

Case definition for novel hyperinflammatory condition seen in children during COVID-19 pandemic from RCPCH and CDC

RCPCH definition of PIMS-TSCDC definition of MIS-C
Child presenting with: Individual of <21 years with:
  • Persistent fever, inflammation (neutrophilia, elevated CRP and lymphopaenia) and evidence of single or multiorgan dysfunction with additional features as indicated further.

  • At least 24 hours of subjective or objective fever >38°C.

  • Severe illness needing admission.

  • Two or more organ systems affected.

Clinical features:
  • Fever >38°C.

  • Abdominal symptoms: pain, diarrhoea and vomiting.

  • Rash/conjunctivitis.

  • Hypotension and shock.

  • Oxygen requirement.

  • Confusion.

  • Cough/respiratory symptoms.

  • Sore throat.

  • Headache.

  • Mucous membrane changes.

  • Neck swelling.

  • Swollen hands and feet/desquamation.

  • Syncope.

  • Fever.

  • Nausea, vomiting and abdominal pain.

  • Rash/conjunctivitis.

  • Headache/meningitis.

  • Extremity swelling with erythema.

  • Skin peeling.

  • Haemodynamic instability.

  • Acute kidney injury.

Laboratory findings: One or more of the following:
  • Raised CRP.

  • Lymphopaenia/neutrophilia.

  • Raised ferritin.

  • Raised fibrinogen.

  • Raised D-Dimer.

  • Abnormal renal profile.

  • Hyponatraemia.

  • Raised troponin and NT-proBNP.

  • Raised CRP, ESR, procalcitonin and IL-6.

  • Lymphopaenia/neutrophilia.

  • Low albumin.

  • Raised ferritin.

  • Raised fibrinogen.

  • Raised D-Dimer.

  • Raised LDH.

This may include children fulfilling full or partial criteria for Kawasaki disease.* Some individuals may fulfil full or partial criteria for Kawasaki disease.*
Exclusion of other microbial causes (bacterial sepsis, streptococcal/staphylococcal shock syndromes, infections associated with myocarditis) but do not delay management while awaiting these results. No alternative plausible diagnosis. Consider MIS-C in any paediatric death with evidence of SARS-CoV-2 infection.
SARS-CoV-2 PCR test results may be positive or negative. Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology or antigen test or COVID-19 exposure within 4 weeks.
  • *Kawasaki disease criteria: 5 days of fever +4/5 clinical features: red rash, red conjunctival injection, red lips and mouth or cracked dry lips, red hands and feet and lymphadenopathy.

  • CDC, Centers for Disease Control and Prevention; CRP, C reactive protein; ESR, erythrocyte sedimentation rate; IL-6, interleukin 6; LDH, lactic acid dehydrogenase; MIS-C, multisystem inflammatory syndrome in children; NT-proBNP, N-terminal pro-B type natriuretic peptide; RCPCH, Royal College of Paediatrics and Child Health; RT-PCR, reverse transcriptase PCR.