Disclosures: Evan R. Zeldin, MD: No financial relationships or conflicts of interest

Case Diagnosis: 5-year-old female presenting with MIS-C secondary to COVID-19

Case Description: Patient presented with a week-long history of fevers and shortness of breath who subsequently developed hypotension and acute respiratory failure. Testing was positive for COVID-19 with elevated inflammatory markers. The patient was found to have an acute kidney injury, myocarditis, and acute heart failure with an ejection fraction of 40%.

Setting: Academic Acute Inpatient Rehabilitation HospitalAssessment/

Results: The patient was treated with milrinone, intravenous immunoglobulin, aspirin, anticoagulation and steroids with resultant normalization of her ejection fraction. However, her weakness persisted throughout her extremities, requiring contact guard to minimal assistance with transfers and ambulation. Patient had decreases in both activity tolerance and balance from her prior baseline and required frequent cueing for improvement. Following a course of acute inpatient rehabilitation, patient was able to ambulate >300 feet and require only supervision assistance with mobility.

Discussion: MIS-C is an acute, rare complication of COVID-19 that develops in children. The current CDC definition of this rapidly evolving syndrome involves a patient under the age of 21 years old presenting with fever, elevated inflammatory markers, and multisystem organ involvement with COVID-19 infection within the prior 4 weeks. The severity of this “Kawasaki-like” illness varies widely. Patients can present with severe neurologic, pulmonary, and cardiac manifestations, including encephalopathy, muscle weakness, brainstem and/or cerebellar signs, arrhythmias, myocardial dysfunction, and respiratory failure resulting in prolonged hospitalizations. This multisystem disease requires a multidisciplinary approach, including cardiopulmonary and/or neurological rehabilitation in order to make functional progress towards a hopeful return to prior level of function.

Conclusion: MIS-C is a rare complication of COVID-19 which can cause serious debilitation in severe cases with multisystem involvement. The criteria, incidence, and treatment of this disease are quickly evolving, yet as the pandemic progresses there will likely be an increasing number of MIS-C cases that require rehabilitation and multidisciplinary, multispecialty care.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/covid-19-pediatric-complications-a-presentation-of-multisystem-inflammatory-syndrome-in-children-mis-c-a-case-report/