PMIS and COVID-19: What to watch for

PMIS, also referred to as multisymptom inflammatory syndrome in children (MSI-C) may be associated with COVID-19 - here are the symptoms and treatments for this condition that can include the typical signs of Kawasaki disease.

Fewer children than adults have been diagnosed with COVID-19. Of children who have been diagnosed, most haven’t been very sick. Some children had cold symptoms, and we know that some children who have tested positive for the coronavirus have had no symptoms at all. However, over the last couple of weeks in the U. S. there have been some children with symptoms that look like Kawasaki disease, up to a month after a COVID-19 infection. The condition, multisymptom inflammatory syndrome in children (MSI-C) or pediatric multisystem inflammatory syndrome (PMIS), could be associated with COVID-19 and has made its way to our region. What should parents look for?

PMIS or MSI-C potentially associated with COVID-19 symptoms

Children with PMIS or MSI-C experience fevers that last for days; some of them are having the typical signs and symptoms seen with Kawasaki disease, a vasculitis, or inflammation of the blood vessels. Symptoms can include:

  • Red eyes (as with conjunctivitis or a very dramatic pinkeye)
  • Red, dry, cracked lips
  • Bright red tongue
  • Rash
  • Swollen hands and feet that may or may not be red

“We’re also seeing kids who are showing up with fever and pretty dramatic belly symptoms,” said Kristina A. Bryant, M.D., pediatric infectious disease specialist with Norton Children’s Infectious Diseases, affiliated with the UofL School of Medicine. “This includes vomiting, diarrhea, belly pain.”

Dr. Bryant emphasizes that the condition is still quite rare.

“Most kids who develop fever are going to have something else, not post-inflammatory syndrome after COVID-19 infection,” Dr. Bryant said. “Kids are still going to get ear infections and sore throat due to strep. We’re moving into tick season, and some of the things that we see with tickborne illness are fever and rash, and potentially red eyes.”

If your child has a fever, it’s important for them to be evaluated by their pediatrician.

Norton Children’s Medical Group

Norton Children’s Medical Group, affiliated with the UofL School of Medicine, offers pediatric primary care at more than 20 locations throughout Louisville and surrounding communities, including Southern Indiana.

Find a pediatrician

“If your child develops a fever that doesn’t go away, call your pediatrician and ask for your child to be evaluated,” Dr. Bryant said. “This can be a phone call or a video visit, but it also may be an in-person visit. It is perfectly safe for children to go to their pediatrician’s office right now.”


Intravenous steroids can be used to reduce inflammation in the body. Intravenous immune globulin, the traditional treatment for Kawasaki disease, can also be used.  IVIG is a blood product that is essentially pooled antibodies from many donors. It’s a blood product with the red cells taken out while the antibodies remain. When given at the right dose, it can suppress inflammation in the body.