# MIS-C Management

> MIS-C for NEET-PG Paediatrics: case definition, Kawasaki differences, IVIG 2 g/kg with steroids, myocarditis and thromboprophylaxis notes.

- Canonical URL: https://prepelephant.com/topics/neet-pg/paediatrics/mis-c-management
- Exam / course: NEET-PG · Subject: Paediatrics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "MIS-C Management", PrepElephant, https://prepelephant.com/topics/neet-pg/paediatrics/mis-c-management

## Direct answer

Multisystem inflammatory syndrome in children (MIS-C) is a delayed, immune-mediated complication appearing two to six weeks after SARS-CoV-2 infection or exposure, defined by fever of three or more days, raised inflammatory markers (C-reactive protein, ferritin and others), involvement of at least two organ systems, and evidence of recent COVID-19 by polymerase chain reaction, serology or epidemiological link, with no alternative diagnosis. It mimics Kawasaki disease but strikes older children, features more gastrointestinal involvement, myocardial dysfunction and shock, and runs lower platelet and lymphocyte counts. Management is intravenous immunoglobulin 2 g/kg plus methylprednisolone (1-2 mg/kg/day, or pulsed 10-30 mg/kg in shock), low-dose aspirin 3-5 mg/kg, thromboprophylaxis with enoxaparin when aneurysms or severe dysfunction exist, and intensive-care support of shock.

## What you must remember

- **Definition skeleton:** fever three days or more, elevated inflammatory markers, multisystem (two or more) organ involvement, evidence of recent SARS-CoV-2, and exclusion of alternatives — five elements an MCQ can test element by element.
- **Kawasaki discriminators:** MIS-C affects older children (median around 8-9 years), has prominent abdominal pain, diarrhoea and vomiting, more myocarditis and shock, and typically shows lymphopenia, thrombocytopenia and markedly raised ferritin and troponin or NT-proBNP.
- **First-line therapy:** intravenous immunoglobulin 2 g/kg with methylprednisolone 1-2 mg/kg/day; shocked or deteriorating children receive pulse methylprednisolone 10-30 mg/kg/day for three days and may need a second immunoglobulin infusion or infliximab.
- **Cardiac monitoring:** troponin and NT-proBNP at presentation, echocardiography on admission and serially; coronary aneurysms occur in a subset and drive antithrombotic intensity.
- **Antithrombotic ladder:** low-dose aspirin 3-5 mg/kg/day for all; enoxaparin added for coronary aneurysms, ejection fraction below about 35-40%, or large aneurysms per protocol.
- **Supportive backbone:** fluid-resuscitate cautiously (myocarditis lurks), start inotropes early (milrinone or adrenaline) for vasodilatory shock, and treat with the same disciplined intensivism as septic shock until inflammation subsides.
- **Recovery rule:** most children improve within days of immunomodulation, and repeat echocardiography plus cardiology follow-up continues until coronary dimensions and ventricular function normalise.

## Managing a shocked child, step by step

A nine-year-old presents with five days of fever, abdominal pain and vomiting, then cold peripheries and a gallop. Step one is simultaneous resuscitation and recognition: fluids in 10 mL/kg aliquots with early reassessment, because a hyperinflammatory myocardium floods with careless volume; early inotropes; and a screen that includes full blood count (anaemia, lymphopenia, thrombocytopenia), C-reactive protein and ferritin (markedly raised), troponin and NT-proBNP (raised), liver and renal function, coagulation and D-dimer, and a SARS-CoV-2 serology or antigen test alongside bacterial cultures. Step two is the echocardiogram: a reduced ejection fraction, valvular regurgitation or coronary changes confirm the syndrome's cardiac axis and escalate care. Step three is immunomodulation — intravenous immunoglobulin 2 g/kg plus pulse methylprednisolone in a shocked child — with careful fluid balance, diuretics for volume overload, and escalation to a second immunoglobulin dose, infliximab or anakinra if fever and dysfunction persist beyond 24-36 hours.

Step four layers the antithrombotic decision on the echo findings: simple illness receives aspirin alone; aneurysms or severe dysfunction add enoxaparin. Step five is the convalescence plan — repeat echo at intervals defined by severity, activity restriction while the ventricle recovers, and live-vaccine deferral after immunoglobulin for about 11 months.

## How the exam frames it

The examinable tension is Kawasaki disease versus MIS-C, and stems are built around the discriminators: age over seven, abdominal pain dominating, shock with a raised troponin, and thrombocytopenia all point to MIS-C, while an irritable infant with strawberry tongue, cracked lips and thrombocytosis points to Kawasaki. The second tested layer is the marker panel — expect a question on which combination supports MIS-C (lymphopenia, high ferritin, raised NT-proBNP or troponin) — and the third is the therapeutic ladder, where IVIG 2 g/kg plus steroids is the expected first-line answer and pulse methylprednisolone the shocked-child upgrade. Indian examiners add the epidemiological angle: waves of MIS-C follow COVID-19 surges by two to six weeks, and a child presenting in that window with fever plus gut symptoms deserves the serology rather than being managed as enteric fever — the commonest real-world misdiagnosis in Indian emergency departments.

## Frequently asked questions

### What defines MIS-C?

Fever of three or more days with raised inflammatory markers, multisystem organ involvement, evidence of recent SARS-CoV-2 infection or exposure, and no alternative explanation — typically two to six weeks after the infection.

### How does MIS-C differ clinically from Kawasaki disease?

Older children, prominent gastrointestinal symptoms, more myocarditis and shock, lymphopenia and thrombocytopenia rather than thrombocytosis, and a higher likelihood of intensive-care admission.

### What is first-line treatment?

Intravenous immunoglobulin 2 g/kg plus methylprednisolone (1-2 mg/kg/day, or pulsed 10-30 mg/kg/day in shock), with supportive intensive care for organ dysfunction.

### When is anticoagulation added to aspirin?

When coronary aneurysms are present, ventricular dysfunction is significant, or D-dimer and risk profiles are high — enoxaparin is the usual agent.

### Which laboratory pattern supports MIS-C?

Lymphopenia, thrombocytopenia, markedly raised C-reactive protein, ferritin and D-dimer, with elevated troponin and NT-proBNP reflecting myocardial involvement.