Abstract:

The false impression that children have been less harmed than adults during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic was invalidated as pediatric cases resembling Kawasaki disease and toxic shock syndrome started to be reported from the United Kingdom in April 2020. We propose that this disease, called coronavirus disease 2019 (COVID-19) related pediatric multisystem inflammatory disease (MIS-C), should be managed in hospital even if the diagnosis is uncertain. In children who have not life-threatening disease, a comprehensive laboratory evaluation should be performed to determine whether the criteria for MIS-C are met and treatment decision should be made after this evaluation. Immunomodulatory treatment should be initiated without waiting for a definitive diagnosis in critically-ill children if the disease is suspected. Children with MIS-C should be followed up in an institution with subspecialists of pediatric infectious diseases, pediatric rheumatology, pediatric cardiology, pediatric intensive care, and pediatric gastroenterology, if possible. We suggest that healthcare workers entering rooms of patients with suspected COVID-19 should be cautious against airborne transmission, although this route is controversial for SARS-CoV-2. Management primarily consists of intravenous immunoglobulin, steroids, biologicals, antithrombotic drugs, and antimicrobial agents. Although duration of therapy is debatable, the prerequisites of discharge are restoration of cardiac function and no fever in the last 24 hours. MIS-C has a favorable prognosis, the case fatality rate being only 1-2%.

Keywords: