Children suffering from coronavirus disease (COVID-19) usually present with mild symptoms and show lower mortality rates than adults. However, there have been several recent reports of more severe hyperinflammatory presentation in pediatric COVID-19 patients. This review article aims to summarize the current literature available on the main clinical features and management approaches of multisystem inflammatory syndrome in children (MIS-C). The authors searched different indexing databases for observational and interventional studies using search terms including “Coronavirus, COVID-19, pediatric, MIS-C, Kawasaki, and inflammation.” The retrieved publications were further assessed for relevance to the topic. Only relevant articles were included in writing this review article. Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory syndrome temporally related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in pediatrics. It is characterized by persistent fever, rash, elevated inflammatory markers, and multiorgan failure with increasing rates of cardiovascular and gastrointestinal involvement. The exact pathophysiologic mechanisms of MIS-C are still unknown, but it is postulated to be due to an exaggerated immune response to SARS-CoV-2 infection. Multisystem inflammatory syndrome in children is diagnosed by exclusion of other underlying causes of organ failure. There is a lack of clinical evidence on the management of MIS-C. The current guidelines depend mainly on expert opinion based on the management of other hyper-inflammatory syndromes in children. Patients suffering from MIS-C are treated with intravenous immunoglobulin (IVIg), corticosteroids, infliximab, tocilizumab, and anakinra. Despite the growing reports on COVID-19 in children, there is still a lot to elucidate on the pathophysiology, diagnosis, and subsequent management of MIS-C. Further trials are needed to investigate new approaches to manage MIS-C. Specific evidence-based guideline for management of MIS-C should be tailored to the current available information on MIS-C.

中文翻译：

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儿童 COVID-19：多系统炎症综合征的治疗方法

患有冠状病毒病 (COVID-19) 的儿童通常症状较轻，死亡率低于成人。然而，最近有几篇报道称儿科 COVID-19 患者出现更严重的炎症表现。这篇综述文章旨在总结目前关于儿童多系统炎症综合征 (MIS-C) 的主要临床特征和管理方法的现有文献。作者使用“冠状病毒、COVID-19、儿科、MIS-C、川崎和炎症”等搜索词，在不同的索引数据库中搜索了观察性和干预性研究。进一步评估检索到的出版物与主题的相关性。在撰写本评论文章时仅包括相关文章。儿童多系统炎症综合征 (MIS-C) 是一种与儿科严重急性呼吸综合征冠状病毒-2 (SARS-CoV-2) 感染在时间上相关的高炎症综合征。它的特点是持续发热、皮疹、炎症标志物升高和多器官衰竭，心血管和胃肠道受累率增加。MIS-C 的确切病理生理机制尚不清楚，但推测是由于对 SARS-CoV-2 感染的过度免疫反应所致。儿童多系统炎症综合征是通过排除器官衰竭的其他潜在原因来诊断的。缺乏管理 MIS-C 的临床证据。目前的指南主要取决于基于儿童其他高炎症综合征管理的专家意见。患有 MIS-C 的患者接受静脉注射免疫球蛋白 (IVIg)、皮质类固醇、英夫利昔单抗、托珠单抗和阿那白滞素治疗。尽管关于儿童 C​​OVID-19 的报道越来越多，但关于 MIS-C 的病理生理学、诊断和后续管理仍有很多需要阐明。需要进一步的试验来研究管理 MIS-C 的新方法。MIS-C 管理的具体循证指南应根据当前可用的 MIS-C 信息量身定制。