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Volume 28, Number 5—May 2022

Multisystem Inflammatory Syndrome in Children after SARS-CoV-2 Vaccination

Eisha Jain, Jeffrey R. Donowitz, Elizabeth Aarons, Beth C. Marshall, and Michael P. MillerComments to Author 
Author affiliations: Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA (E. Jain); Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond (J.R. Donowitz, E. Aarons, B.C. Marshall, M.P. Miller)

Main Article


Data for 2 adolescent patients experiencing multisystem inflammatory syndrome after initial dose of BNT162b2 vaccination against severe acute respiratory syndrome coronavirus 2, United States*

Data Patient 1 Patient 2
Age, y/sex
Underlying conditions
Asthma, seasonal allergies
Time since BNT162b2 dose, d
Initial symptoms
102°F fever, headache, nonbilious emesis, myalgias, chest pain, diffuse blanching rash
103.1°F fever, headache, abdominal tenderness, fatigue, myalgias, and costovertebral angle tenderness
Initial vital signs
Blood pressure 115/56 mm Hg, pulse 105 beats/min, temperature 100.4°F, respiratory rate 20 breaths/min, oxygen saturation 100%, weight 60.8 kg
Blood pressure 104/59 mm Hg, pulse 124 beats/min, temperature 103.1°F, respiratory rate 18 breaths/min, oxygen saturation 99%, weight 58 kg
Laboratory test results (reference range)
Leukocytes, K/μL (4.2–9.4) 17 21.1
% PMNs (39–74) 91 90
% Lymphocytes (18–50) 3 5
CRP, mg/dL (0–0.60) 15.1 36.7
ESR, mm/H (0–15) 13 83
LDH, U/, sL (130–230) 176 326
Fibrinogen, mg/dL (200–475) 516 >800
Prothrombin time, s (9–11.1) 11.4 11.3
BNP, pg/mL (<125) 169 560
Troponin, ng/mL (<0.05) <0.05 0.18
D-dimer, mg/L (0–0.65) 2.84 2.58
Creatinine, mg/dL (0.3–1.10) 0.92 1.39
AST U/L (15–37) 16 71
ALT, U/L (12–78) 22 73
Alkaline phosphate, U/L (40–120)
Additional work-up
Urinalysis Trace protein, large blood, moderate leukocyte esterase, 10–20 leukocytes, 1+ bacteria 100 mg/dL of protein, moderate blood, moderate leukocyte esterase, 10–20 leukocytes, 5–10 red blood cells, no bacteria
Urine culture Not performed 10,000 CFUs Escherichia coli
Blood culture Not performed Negative
Chest radiograph No abnormal findings No abnormal findings
Chest CT No abnormal findings Not performed
Electrocardiogram No abnormal findings Sinus tachycardia, nonspecific T-wave abnormalities
Echocardiogram No abnormal findings No abnormal findings
Abdomen/pelvis CT
Not performed
Diffuse left renal enlargement, possible polycystic ovaries
COVID-19 labs
Nasopharyngeal RT-PCR Negative Negative
Spike antibody Negative Positive
Nucleocapsid antibody
Not performed
PICU admission
2 g/kg IVIG
2 g/kg IVIG for 1 d, 30 mg IV methylprednisolone 2×/d for 3 d to continue at home orally for 2 d then 2–3 wk steroid taper, 325 mg aspirin reduced to 81 mg on day 3, cefdinir 7 d course
Length of hospital stay 1 d 3 d

*BNT162b2, Pfizer-BioNTech ( ALT, alanine transaminase; AST, aspartate transaminase; BNP, brain natriuretic peptide; COVID-19, coronavirus disease; CRP, C-reactive protein; CT, computed tomography; ESR, erythrocyte sedimentation rate; IVIG, intravenous immune globulin; LDH, lactate dehydrogenase; PICU, pediatric intensive care unit; PMN, polymorphonuclear cells; RT-PCR, reverse transcription PCR.

Main Article

Page created: March 01, 2022
Page updated: April 19, 2022
Page reviewed: April 19, 2022
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