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Complications and Prognosis
Screening and Prevention
Admission is recommended for children who meet MIS-C criteria, preferably to a hospital with a pediatric ICU r3
Excellent supportive care is essential in all cases; antiinflammatory and immunomodulatory therapies have been used in severely ill patients (particularly those who fulfill criteria for Kawasaki disease) r4r5r6r7r22r23
For patients who meet Kawasaki disease criteria, consider treating with IV immunoglobulin and aspirin; Kawasaki disease guidelinesr11 encourage treatment as early as the diagnosis is established and preferably within 10 days of illness onset r4r26d1
For patients who meet criteria for toxic shock, consider using IV immunoglobulin r4d3
IV immunoglobulin has also been used successfully in children who do not meet criteria for Kawasaki disease or toxic shock but who do have severe manifestations of MIS-C, including myocarditis, shock, persistent fever, and elevated inflammatory markers or other clinical indicators of severe illness. Consider such therapy for critically ill patients even before the evaluation is completer22r7r9r30r31d7
Glucocorticoids are commonly used in conjunction with IV immunoglobulin or as follow-up to it if response is less than desired r22
Other treatments that have been associated with apparently successful outcomes include infliximab, anakinra, and tocilizumab, but data are scant and noncomparative r2r7r8r9r10
For patients in whom sepsis caused by other pathogens has not been ruled out, begin empiric antibiotics, which can be de-escalated if indicated based on results of microbiologic studies r6d4
Because MIS-C appears to be a postinfectious inflammatory response, antiviral therapy generally has not been initiated; nevertheless, use of infection control precautions appropriate for COVID-19 is recommended by some authorities r4
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