Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2
Diagnosis and Treatment Approach
- The American College of Rheumatology recommends initiating combination therapy with IVIG 2 gm/kg and methylprednisolone 1-2 mg/kg/day as first-line treatment for confirmed MIS-C 1, 2
- For mild cases without life-threatening features, complete diagnostic evaluation should be done before initiating immunomodulatory treatment, and some patients may only require close monitoring without immediate treatment 3, 4, 5, 6
- In moderate-to-severe cases or life-threatening manifestations, treatment should be initiated before full diagnostic evaluation is completed, with IVIG dosing based on ideal body weight and assessment of cardiac function and fluid status before administration 1, 2, 3, 4
- The American Heart Association recommends low-dose aspirin for patients with Kawasaki disease-like features and/or thrombocytosis, and therapeutic anticoagulation with enoxaparin for documented thrombosis or ejection fraction <35% 7, 8
Intensification Therapy for Refractory Disease
- Refractory disease is defined as persistent fevers and/or ongoing significant end-organ involvement despite first-line therapy, and options for intensification include high-dose methylprednisolone and high-dose anakinra 1, 2, 3, 7, 8
Cardiac Monitoring Requirements
- Echocardiogram schedule should include evaluation at diagnosis, 7-14 days, and 4-6 weeks after presentation, with more frequent monitoring required for LV dysfunction and/or coronary artery aneurysms 3, 4, 5
- EKG monitoring should be done every 48 hours minimum while hospitalized and during follow-up, with continuous telemetry if conduction abnormalities present 3, 4, 5
- Cardiac biomarkers such as BNP and troponin T should be trended until normalization 3, 5, 6