COVID-19 and multisystem inflammatory syndrome in children: Viva

Branch 1: Recognising the post-COVID hyperinflammatory emergency

The candidate should immediately recognise that this school-age child with persistent fever, multiorgan involvement (gastrointestinal symptoms, mucocutaneous features, shock), and a SARS-CoV-2 exposure three weeks earlier has multisystem inflammatory syndrome in children until proven otherwise. The key discriminating feature is the temporal relationship: the recent febrile illness two to six weeks earlier is the trigger, and the current presentation is the delayed post-infectious hyperinflammatory phenotype, not acute COVID-19. ^[1]

The candidate should state that any school-age child with persistent fever and organ dysfunction in the weeks after a COVID-19 illness must be presumed to have multisystem inflammatory syndrome until proven otherwise, and that the first priority is resuscitation of the shock and the early echocardiogram, because cardiac involvement is what makes this condition lethal. The alternative of bacterial sepsis must be covered empirically while the workup proceeds. ^[1]