Multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome: Clinical guidelines

Multisystem inflammatory syndrome in children (MIS-C), also called pediatric inflammatory multisystem syndrome (PIMS), is an inflammatory condition that follows infection with SARS-CoV-2. Initially described as a Kawasaki disease (KD)-like illness that occurred 2–6weeks after infection, the epidemiology of the condition has changed with strain variation. Although the pathophysiology is still unclear, generally, the data suggest that KD and MIS-C are not directly related. The diagnosis of MIS-C cases will become even more challenging as vaccine uptake and natural immunity in previously infected persons lead to new strains or lower circulating rates of SARS-CoV-2 infection, causing cases to become more sporadic. Initial treatments and approaches were based on KD; however, due to distinct differences in the presentation and clinical characteristics of these conditions, approaches to immunomodulation in these conditions are different. Myocardial dysfunction is particularly notable and concerning in the presentations of MIS-C. Outlined herein, therapies are targeted at decreasing the inflammatory response as well as anticoagulation and supportive care. Controversies in care and future considerations will also be discussed.