Table 2.

MIS-C treatment algorithm

Hospitalized patient with MIS-C [51–53]
Patient hemodynamically stable without severe features	Patient with hypotensive shock, respiratory failure, severe neurologic involvement
First-line treatment	First-line treatment
IVIG 2 g/kg	IVIG 2 g/kg + methylprednisolone 1–2 mg/kg/day
Monitor for improvement in fever curve, inflammatory markers	If life or organ threatening disease, consider methylprednisolone 10–30 mg/kg/day
Second-line treatment for refractory disease	Second-line treatment for refractory disease
Addition of methylprednisolone 1–2 mg/kg/day	Intensify steroid regimen to methylprednisolone 10–30 mg/kg/day
Consider alternative second-line agent (anakinra, infliximab, etc.)	Addition of high-dose anakinra or alternative second-line agent
Additional medications
Initiate anti-platelet therapy with aspirin 3–5 mg/kg daily (max. 81 mg/day)	Initiate anticoagulation vs anti-platelet therapy; hold anti-platelet therapy for significant thrombocytopenia
If on steroids and aspirin, initiate gastric prophylactic medication	If on high-dose steroids ± aspirin, initiate gastric prophylactic medication