BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a dangerous 
pediatric complication of COVID-19.
OBJECTIVE: The purpose of this review article is to provide a summary of the 
diagnosis and management of MIS-C with a focus on management in the acute care 
setting.
DISCUSSION: MIS-C is an inflammatory syndrome which can affect nearly any organ 
system. The most common symptoms are fever and gastrointestinal symptoms, though 
neurologic and dermatologic findings are also well-described. The diagnosis 
includes a combination of clinical and laboratory testing. Patients with MIS-C 
will often have elevated inflammatory markers and may have an abnormal 
electrocardiogram or echocardiogram. Initial treatment involves resuscitation 
with careful assessment for cardiac versus vasodilatory shock using 
point-of-care ultrasound. Treatment should include intravenous immunoglobulin, 
anticoagulation, and consideration of corticosteroids. Interleukin-1 and/or 
interleukin-6 blockade may be considered for refractory cases. Aspirin is 
recommended if there is thrombocytosis or Kawasaki disease-like features on 
echocardiogram. Patients will generally require admission to an intensive care 
unit.
CONCLUSION: MIS-C is a condition associated with morbidity and mortality that is 
increasingly recognized as a potential complication in pediatric patients with 
COVID-19. It is important for emergency clinicians to know how to diagnose and 
treat this disorder.