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| PIMS | |
|---|---|
| Name | PIMS |
| Synonyms | Pediatric multisystem inflammatory syndrome, multisystem inflammatory syndrome in children (MISC) — do not use as links |
| Specialty | Pediatrics, Infectious disease medicine, Rheumatology |
| Symptoms | fever, rash, conjunctivitis, shock, gastrointestinal pain |
| Onset | days to weeks after SARS-CoV-2 exposure |
| Causes | post-infectious immune dysregulation after SARS-CoV-2 infection |
| Risks | recent COVID-19 pandemic infection, younger age groups |
| Diagnosis | clinical criteria, laboratory markers, imaging |
| Treatment | immunomodulation, supportive care, vasoactive agents |
| Prognosis | variable; most recover with treatment, some have cardiac sequelae |
PIMS is a pediatric hyperinflammatory condition temporally associated with SARS-CoV-2 exposure that affects multiple organ systems. It emerged during the COVID-19 pandemic and has been characterized by fever, systemic inflammation, and cardiovascular involvement in children and adolescents. Recognition required coordination among World Health Organization, Centers for Disease Control and Prevention, and regional pediatric societies to establish case definitions and management pathways.
The syndrome was defined by public health authorities including World Health Organization, Centers for Disease Control and Prevention, and national health agencies during the COVID-19 pandemic to describe a post-infectious inflammatory state in children following SARS-CoV-2 circulation. Terminology varied across jurisdictions with overlapping terms used by Royal College of Paediatrics and Child Health, European Centre for Disease Prevention and Control, and regional pediatric societies. Clinical criteria often incorporated laboratory markers endorsed by organizations such as American Academy of Pediatrics and specialist consensus from groups like European Society for Paediatric Infectious Diseases.
Reports originated from locations with high SARS-CoV-2 incidence including clusters described in United Kingdom, United States, Italy, France, and Spain. Case series published by institutions such as Great Ormond Street Hospital and large healthcare systems in New York City documented age distributions skewed toward school-aged children and adolescents, with median ages reported by teams at Children's Hospital of Philadelphia and Boston Children's Hospital. Epidemiological analyses from Johns Hopkins University and national public health agencies indicated temporal lag of weeks after regional COVID-19 pandemic peaks and variable incidence across populations studied by researchers at Imperial College London and Mount Sinai Health System.
Leading hypotheses implicate post-infectious immune dysregulation after exposure to SARS-CoV-2 with parallels drawn to inflammatory responses described in literature by investigators at National Institutes of Health and academic centers such as Stanford University School of Medicine. Proposed mechanisms include aberrant cytokine release involving mediators studied by teams at Karolinska Institutet and complement activation pathways characterized by researchers at University of Oxford. Genetic predispositions have been explored in cohorts from University College London and Harvard Medical School, while immunophenotyping work from Institut Pasteur and Wellcome Trust Sanger Institute examined adaptive and innate immune signatures.
Presentation commonly includes persistent fever, mucocutaneous findings, conjunctival injection, abdominal pain, and signs of cardiovascular compromise as documented in case series from Children's Hospital Los Angeles and Toronto SickKids Hospital. Diagnostic strategies combine laboratory markers—elevated C-reactive protein, ferritin, troponin—documented by researchers at Mayo Clinic and imaging such as echocardiography performed in centers like Cincinnati Children's Hospital Medical Center. Public health case definitions from World Health Organization and Centers for Disease Control and Prevention guided clinician recognition, while multicenter registries coordinated by Vanderbilt University Medical Center and University of California, San Francisco compiled diagnostic data.
Differential considerations included entities characterized by systemic inflammation: classic and atypical presentations reported in Kawasaki disease literature from National Heart, Lung, and Blood Institute; sepsis syndromes reviewed by authors at University of Oxford; macrophage activation syndromes studied at Mount Sinai Hospital; and toxic shock syndromes described in reports from Centers for Disease Control and Prevention. Distinction relied on epidemiologic context of prior SARS-CoV-2 exposure and specific laboratory and cardiac imaging profiles.
Treatment paradigms were informed by immunomodulatory strategies used in pediatric inflammatory diseases and developed collaboratively by centers including Great Ormond Street Hospital, Boston Children’s Hospital, and Royal Hospital for Children Glasgow. Common interventions included intravenous immunoglobulin protocols adapted from Kawasaki disease management, corticosteroid regimens evaluated in multicenter studies coordinated by Pediatric Infectious Diseases Society, and biologic agents targeting cytokines as investigated in trials at National Institutes of Health and academic centers such as University of Cambridge. Supportive care, hemodynamic stabilization, and anticoagulation strategies were provided in pediatric intensive care units at institutions like St. Mary's Hospital and Ann & Robert H. Lurie Children's Hospital of Chicago.
Most cohorts reported by investigators at Johns Hopkins Hospital and Children's Hospital of Philadelphia described favorable short-term outcomes with recovery after prompt therapy, but cardiac sequelae including coronary artery changes and myocardial dysfunction were observed in follow-up studies by teams at Mount Sinai Health System and Hospital for Sick Children. Long-term surveillance efforts were launched by organizations such as European Society for Paediatric Cardiology and national public health agencies to monitor sequelae, with registries maintained by centers including Vanderbilt University Medical Center and University of Washington.
Category:Pediatric inflammatory syndromes