AUTHOR=Licciardi Francesco , Baldini Letizia , Dellepiane Marta , Covizzi Carlotta , Mogni Roberta , Pruccoli Giulia , Orsi Cecilia , Rabbone Ivana , Parodi Emilia , Mignone Federica , Montin Davide 

TITLE=MIS-C Treatment: Is IVIG Always Necessary?

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 9 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.753123

DOI=10.3389/fped.2021.753123

ISSN=2296-2360

ABSTRACT=MIS-C is a severe inflammatory syndrome associated with SARS-CoV-2 exposure. Intravenous immunoglobulin (IVIG) is considered the first-tier therapy, but it implies infusion of large fluid volumes that may worsen cardiac function. Since April 2020 we have developed a treatment protocol designed for decreasing the need of IVIG in the early phase of MIS-C. In the last year, 31 patients have been treated with this protocol: 25 with high dose pulse methylprednisolone (MP, 10 mg/Kg) and 6 with 2mg/Kg. 67.7% of the patients responded to the initial treatment, the others needed a step-up either with Anakinra (25.8%) or MP dose increase (6.5%). IVIG treatment was added in 4 patients.
In our cohort only 1 patient (3.2%) needed ICU admission or inotropic support, 1 patient developed a small coronary artery aneurysm (3.2%). Timely start of MP therapy and careful fluid management might improve the outcomes in MIS-C.