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Paediatric rheumatology in 2022

MIS-C: myths have been debunked, but mysteries remain

Nature Reviews Rheumatology volume 19, pages 70–71 (2023)Cite this article

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Although elegant work has detailed the clinical presentation, immune response and disease outcome of multisystem inflammatory syndrome in children, many questions remain. Studies in 2022 have explored the nature of the vascular injury, the role of the SARS-CoV-2 spike protein and the association with the current variants of the virus.

Key advances

  • Although coronary artery dilation is associated with both multisystem inflammatory syndrome in children (MIS-C) and Kawaski disease, there is currently no evidence of long-term coronary artery damage in MIS-C2.

  • The SARS-CoV-2 spike protein does not seem to act as a superantigen that binds the Vβ-chain of the T cell receptor6; the skewing of Vβ21.3 expression on T cells in children with MIS-C is most likely attributable to a non-SARS-CoV-2 related antigen7.

  • The incidence and severity of MIS-C declined during the Omicron wave of the COVID-19 pandemic as compared with earlier waves, although the precise reason for this decline remains to be determined10.

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Fig. 1: Contrasting vascular injury in MIS-C and Kawasaki disease.

References

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Acknowledgements

The author thanks C. Shimizu for assistance with preparation of the figure.

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  1. Department of Pediatrics, UCSD School of Medicine and Rady Children’s Hospital, La Jolla, CA, USA

    Jane C. Burns

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  1. Jane C. Burns
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Correspondence to Jane C. Burns.

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Burns, J.C. MIS-C: myths have been debunked, but mysteries remain. Nat Rev Rheumatol 19, 70–71 (2023). https://doi.org/10.1038/s41584-022-00896-z

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