Corticosteroid Therapy in Multisystem Inflammatory Syndrome in Adults

Introduction to Corticosteroid Use

The American College of Rheumatology recommends initiating methylprednisolone at 1-2 mg/kg/day IV as the primary corticosteroid for MIS-A, based on extrapolation from pediatric MIS-C guidelines and adult case series 4
Methylprednisolone is preferred over other corticosteroids due to superior tissue penetration and longer residence time 1

The Society of Critical Care Medicine and European Society of Intensive Care Medicine guidelines recommend against corticosteroids in major trauma-related SIRS, finding no mortality benefit (RR 1.00, 95% CI 0.89-1.13) across 19 trials with over 12,000 patients 1, 2, 3
Escalate to high-dose methylprednisolone 10-30 mg/kg/day IV if patients demonstrate persistent fever, ongoing significant end-organ involvement, or progressive deterioration despite initial therapy 4

Taper corticosteroids slowly over 6-14 days, not abruptly, to prevent rebound inflammatory response 1, 2, 3
Rapid discontinuation (2-4 days) or abrupt cessation can lead to clinical deterioration from reconstituted inflammation 1

Implement heightened infection surveillance because glucocorticoids blunt the febrile response, potentially masking hospital-acquired infections 1, 2, 3
Expect hyperglycemia, particularly within 36 hours of initial dosing, though this is not associated with increased morbidity 1, 2
Monitor for electrolyte disturbances and fluid status, especially in patients with cardiac dysfunction 4, 5