{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T20:41:58Z","timestamp":1793911318627,"version":"4.8.0"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Res"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multisystem Inflammatory Syndrome in Children (MIS-C) encompasses a spectrum of phenotypes: shock, Kawasaki disease (KD), and fever with hyperinflammation. Whether MIS-C is a new syndrome or SARS-CoV-2-triggered KD remains debated. To explore this, we investigated the relationship between clinical phenotypes and viral variants, and the contribution of pre-pandemic KD incidence to MIS-C reporting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Single center, prospective, observational study of 384 patients with MIS-C, from March 2020 to September 2023. Clinical and laboratory features, complications, and outcomes were evaluated across the MIS-C waves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three clinical phenotypes were identified: shock, KD, and fever with hyperinflammation. KD was most common across all variants, particularly during Omicron, while shock predominated in Delta cohort. Stratifying by phenotype outperformed the WHO MIS-C and RCPCH PIMS definitions in distinguishing subgroups. Countries with low pre-pandemic KD incidence identified MIS-C as a new syndrome, while countries with high KD incidence did not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MIS-C phenotypes vary accordingly to SARS-CoV-2 variants, with KD being most common. Stratification by clinical phenotypes out-performed MIS-C case definitions for patient identification, highlighting the value of clinical features in managing infection-triggered hyperinflammation. These findings, coupled with the inverse relationship between pre-pandemic KD incidence and MIS-C reporting, support the hypothesis that MIS-C is SARS-CoV-2-triggered KD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>KD and MIS-C are not separate entities but different ends of the immune response spectrum.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Among the hyperinflammation spectrum, each viral variant induces a distinct MIS-C phenotype, with the Omicron wave resembling KD.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Clinical phenotype stratification outperformed MIS-C definitions in identifying patient subgroups, confirming the value of clinical features in managing infection-triggered hyperinflammation.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>The inverse relationship between pre-pandemic KD incidence and MIS-C reporting supports MIS-C being a SARS-CoV-2\u2013triggered KD, underscoring critical equity and diversity considerations.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>A pathogen-agnostic approach to post-infectious hyperinflammation would recognize the full spectrum of phenotypes and complications and avoid confusion due to new naming conventions.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41390-025-04499-8","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:50:49Z","timestamp":1761562249000},"page":"2267-2273","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Multisystem inflammatory syndrome in children is a SARS-CoV-2 triggered Kawasaki disease"],"prefix":"10.1038","volume":"99","author":[{"given":"Greta","family":"Mastrangelo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Tsoukas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Go","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur Hoi Hin","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rae S. 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