Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
New evaluation for suspected or confirmed MIS-C
(Specify) Symptoms can vary but often include:
Fever (persistent for several days)
Abdominal pain, vomiting, diarrhea
Skin rash (non-purulent maculopapular)
Conjunctivitis (redness of the eyes)
Mucous membrane inflammation (mouth, lips)
Lymphadenopathy (swollen lymph nodes)
Cardiac involvement (symptoms may include chest pain, shortness of breath, fatigue)
History of Present Illness:
Onset, duration, and severity of symptoms.
Recent history of COVID-19 infection (may or may not be present).
Prior exposure to someone with COVID-19.
Past Medical History:
Underlying medical conditions (important to consider other potential diagnoses).
History of allergies or prior medication reactions.
Family History:
Family history of COVID-19 infection.
Medications:
List all current medications, including any recently started medications.
Social History:
Recent travel or exposures that could increase risk of infections.
Physical Exam:
Vital signs: Assess for fever, tachycardia (fast heart rate), tachypnea (rapid breathing).
General examination: Look for signs of rash, conjunctivitis, mucous membrane inflammation, lymphadenopathy.
Cardiovascular examination: Assess for heart murmurs, signs of heart failure.
Respiratory examination: Assess for lung sounds and respiratory distress.
Abdominal examination: Assess for tenderness, organomegaly (enlarged organs).
Laboratory Tests:
Complete blood count (CBC): May show elevated inflammatory markers (CRP, ESR), leukocytosis (high white blood cell count), lymphopenia (low lymphocyte count).
Electrolytes: May show abnormalities due to dehydration or inflammation.
C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): Elevated levels indicate inflammation.
Ferritin: May be elevated in some cases of MIS-C.
D-dimer: May be elevated if there is blood clotting.
COVID-19 testing (PCR or antigen): May be positive or negative depending on the timing relative to potential exposure.
Inflammatory markers (cytokine panel): May be used to assess the severity of the inflammatory response (not routinely done in all cases).
Imaging Studies:
Chest X-ray: May show signs of inflammation or fluid in the lungs.
Echocardiogram: Essential to assess for cardiac involvement (reduced heart function, pericardial effusion).
Abdominal ultrasound: May be used to assess for signs of inflammation in the abdominal organs (not routinely done in all cases).
Assessment:
Suspected or confirmed MIS-C: Based on clinical presentation (fever, multisystem involvement), laboratory findings (elevated inflammatory markers), and supportive imaging studies (echocardiogram abnormalities).
Confirmed MIS-C requires meeting specific criteria established by health organizations (e.g., Centers for Disease Control and Prevention (CDC)).
Differential Diagnoses:
Consider other conditions that can cause similar symptoms:
Kawasaki disease
Toxic shock syndrome (TSS)
Sepsis
Appendicitis
Plan:
Management depends on the severity of illness and specific organ involvement. The goal is to suppress inflammation, support organ function, and prevent complications. Treatment may include:
Immunoglobulin therapy (IVIG): First-line treatment to suppress inflammation.
Corticosteroids: May be used in severe cases or if IVIG is not effective.
Anti-inflammatory medications (e.g., aspirin, anakinra) – May be used in specific cases.
Supportive care: Intravenous fluids, medications for heart failure or other organ dysfunction.
Cardiac monitoring: Close monitoring with echocardiograms to assess for ongoing cardiac involvement.
Follow-up: Regular follow-up visits to monitor recovery and assess for long-term complications.
Education:
Educate the patient and family about MIS-C, its symptoms, and potential complications.
Discuss the treatment plan and potential side effects.
Advise on the importance of follow-up care