OBJECTIVE: Multisystem inflammatory syndrome in children (MIS-C) associated with 
coronavirus disease (COVID-19) is a rare and challenging diagnosis requiring 
early treatment. The diagnostic criteria involve clinical, laboratory, and 
complementary tests. This review aims to draw pediatrician attention to this 
diagnosis, suggesting early treatment strategies, and proposing a pediatric 
emergency care flowchart.
SOURCES: The PubMed/MEDLINE/WHO COVID-19 databases were reviewed for original 
and review articles, systematic reviews, meta-analyses, case series, and 
recommendations from medical societies and health organizations published 
through July 3, 2020. The reference lists of the selected articles were manually 
searched to identify any additional articles.
SUMMARY OF THE FINDINGS: COVID-19 infection is less severe in children than in 
adults, but can present as MIS-C, even in patients without comorbidities. There 
is evidence of an exacerbated inflammatory response with potential systemic 
injury, and it may present with aspects similar to those of Kawasaki disease, 
toxic shock syndrome, and macrophage activation syndrome. MIS-C can develop 
weeks after COVID-19 infection, suggesting an immunomediated cause. The most 
frequent clinical manifestations include fever, gastrointestinal symptoms, rash, 
mucous membrane changes, and cardiac dysfunction. Elevated inflammatory markers, 
lymphopenia, and coagulopathy are common laboratory findings. Supportive 
treatment and early immunomodulation can control the intense inflammatory 
response and reduce complications and mortality.
CONCLUSIONS: MIS-C associated with COVID-19 is serious, rare, and potentially 
fatal. The emergency department pediatrician must recognize and treat it early 
using immunomodulatory strategies to reduce systemic injury. Further studies are 
needed to identify the disease pathogenesis and establish the most appropriate 
treatment.