TDNet Discover

Background: Multisystem Inflammatory Syndrome (MIS-C) is a poorly understood complication of viral infection with COVID-19 that can have a significant impact on pediatric patients. The disease resembles Kawasaki Disease (KD), and in the midst of the pandemic, MIS-C was treated in a similar manner to KD;however, an international precedent for first-line treatment has not been set. There is ample evidence that MIS-C is treated differently worldwide. Purpose: To determine the optimal treatment for MIS-C according to the most current evidence-based literature. Methods: An evidence-based clinical review of literature related to COVID-associated MIS-C was performed through 3 databases: PubMed, Google Scholar, and UpToDate. Final article selection was based on full-text review, adherence to inclusion and exclusion criteria, and agreement amongst 3 independent researchers. Three articles were chosen, and results were categorized appropriately. Results: Database searches resulted in three articles carefully selected by the research team;all three articles were approved by an independent South College panel. These studies included a combined total of 2,572, and a meta-analysis which reviewed an additional 98 studies. MIS-C is a serious complication of COVID-19 in pediatric patients which symptomatically resembles KD, and it can be difficult to differentiate between the two. The diagnosis requires an extensive work-up with associated lab work and imaging, all of which can be more closely clinically correlated to a diagnosis of MIS-C. Although there was not a well-defined standard of care at the time this research was performed, many providers employ similar plans for treatment. Common treatment options include: intravenous immunoglobulin (IVIG), glucocorticoids, and biologic agents. There appear to be a large number of factors which impact patient success, including the medications used within the patient’s individualized treatment plan. Conclusion: At the time this research was completed, there were no definitive treatment options designed specifically for the viral complication MIS-C, nor were there any treatment options that guaranteed success without long-term consequences. Sufficient evidence was found to suggest that beyond the baseline treatment of the condition and its clinical manifestations, the addition of glucocorticoids improved patient outcomes and was associated with a faster recovery. Further, the use of biologic agents in refractory patients was not associated with a known increase in patient morbidity or mortality.