• Michael Gottlieb, Rachel Bridwell, Joseph Ravera, and Brit Long.
• Department of Emergency Medicine, Rush University Medical Center, USA. Electronic address: michaelgottliebmd@gmail.com.
• Am J Emerg Med. 2021 Nov 1; 49: 148152148-152.

BackgroundMultisystem inflammatory syndrome in children (MIS-C) is a dangerous pediatric complication of COVID-19.ObjectiveThe purpose of this review article is to provide a summary of the diagnosis and management of MIS-C with a focus on management in the acute care setting.DiscussionMIS-C is an inflammatory syndrome which can affect nearly any organ system. The most common symptoms are fever and gastrointestinal symptoms, though neurologic and dermatologic findings are also well-described. The diagnosis includes a combination of clinical and laboratory testing. Patients with MIS-C will often have elevated inflammatory markers and may have an abnormal electrocardiogram or echocardiogram. Initial treatment involves resuscitation with careful assessment for cardiac versus vasodilatory shock using point-of-care ultrasound. Treatment should include intravenous immunoglobulin, anticoagulation, and consideration of corticosteroids. Interleukin-1 and/or interleukin-6 blockade may be considered for refractory cases. Aspirin is recommended if there is thrombocytosis or Kawasaki disease-like features on echocardiogram. Patients will generally require admission to an intensive care unit.ConclusionMIS-C is a condition associated with morbidity and mortality that is increasingly recognized as a potential complication in pediatric patients with COVID-19. It is important for emergency clinicians to know how to diagnose and treat this disorder.Copyright © 2021 Elsevier Inc. All rights reserved.

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