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Background: MIS-C is a potentially severe inflammatory syndrome associated with SARS-CoV-2 exposure. Intravenous immunoglobulin (IVIG) is considered the first-tier therapy, but it implies infusion of large fluid volumes that may worsen cardiac function.Patients and Methods: Since April 2020, we have developed a treatment protocol that avoids the infusion of IVIG as first-line therapy in the early phase of MIS-C. In this study, we retrospectively analyzed a cohort of consecutive patients treated according to this protocol between 01/04/2020 and 01/04/2021.Results: In the last year, 31 patients have been treated according to the protocol: 25 with high-dose pulse MP (10 mg/kg) and 6 with 2 mg/kg. 67.7% of the patients responded to the initial treatment, while the others needed a step-up, either with Anakinra (25.8%) or with MP dose increase (6.5%). IVIG was administered in four patients. Overall, only one patient (3.2%) needed ICU admission and inotropic support; one patient developed a small coronary artery aneurysm.Conclusions: Timely start of MP therapy and careful fluid management might improve the outcomes of MIS-C patients.

Since April 2020, an increasing number of authors have reported a new clinical syndrome related to SARS-COV2 infection in children, characterized by rapidly progressive systemic inflammation with multiorgan dysfunction. This syndrome has been addressed with many names since its description such as Multisystem Inflammatory Syndrome in children (MIS-C), Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-ST), and SARS-CoV-2-Induced Kawasaki-Like Hyperinflammatory Syndrome (SCiKH).1-3 The pathogenesis of MIS-C is still unknown, even if the positivity of a nasopharyngeal RT-PCR assay for the SARS-COV2 and/or of specific antibody testing in most patients suggests that this syndrome develops while the immune system is activated against the SARS-COV2 virus.