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=9

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=<p><bold>Background:</bold> MIS-C is a potentially 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.</p><p><bold>Patients and Methods:</bold> Since April 2020, we have developed a treatment protocol that avoids the infusion of IVIG as first-line therapy in the early phase of MIS-C. In this study, we retrospectively analyzed a cohort of consecutive patients treated according to this protocol between 01/04/2020 and 01/04/2021.</p><p><bold>Results:</bold> In the last year, 31 patients have been treated according to the protocol: 25 with high-dose pulse MP (10 mg/kg) and 6 with 2 mg/kg. 67.7% of the patients responded to the initial treatment, while the others needed a step-up, either with Anakinra (25.8%) or with MP dose increase (6.5%). IVIG was administered in four patients. Overall, only one patient (3.2%) needed ICU admission and inotropic support; one patient developed a small coronary artery aneurysm.</p><p><bold>Conclusions:</bold> Timely start of MP therapy and careful fluid management might improve the outcomes of MIS-C patients.</p>