# MIS-C: Diagnosis, Management, and Outcomes

## TL;DR

This paper reviews the diagnosis and treatment of a rare inflammatory condition in children linked to COVID-19, highlighting management strategies and ongoing challenges.

## Contribution

A comprehensive synthesis of MIS-C management strategies and diagnostic challenges, emphasizing global variations and knowledge gaps.

## Key findings

- MIS-C is characterized by fever, shock, and multiorgan involvement, requiring immunomodulatory treatment.
- Diagnostic ambiguity and heterogeneous management guidelines remain significant clinical challenges.
- Long-term follow-up is crucial to monitor cardiac, gastrointestinal, and neurologic complications.

## Abstract

Multisystem inflammatory syndrome in children (MIS-C) is an emergent postinfectious hyperinflammatory disorder predominantly affecting the pediatric population following COVID-19 infection. Clinically, it is characterized by persistent fever, shock, multiorgan involvement, and potentially severe cardiovascular involvement. This comprehensive review synthesizes current evidence on the epidemiology, pathophysiology, clinical presentation, diagnostic criteria, with particular emphasis on the management of MIS-C. We also stress on the importance of distinguishing MIS-C from phenotypically similar entities. Acute-phase management centers on supportive care, hemodynamic stabilization, and targeted immunomodulation, with intravenous immunoglobulin, corticosteroids, and biologic forming the therapeutic cornerstone. Thromboprophylaxis is frequently warranted due to the elevated thromboembolic risk, and long-term follow-up is essential to monitor for cardiac, gastrointestinal, and neurologic complications. Additional considerations include postrecovery vaccination protocols and the use of extracorporeal membrane oxygenation in cases of refractory cardiorespiratory failure. Despite advancements in clinical outcomes, diagnostic ambiguity and heterogeneous management guidelines continue to pose significant challenges.

This review outlines current strategies for diagnosing and managing multisystem inflammatory syndrome in children (MIS-C), emphasizing clinical features, differential diagnosis, immunomodulatory treatment, and long-term outcomes, while highlighting knowledge gaps and variations across global health guidelines.