Infliximab in treatment of refractory multisystem inflammatory syndrome in children with severe cardiac dysfunction

Multisystem inflammatory syndrome in children (MIS-C) has emerged as one of the several challenges thrown by the ongoing severe acute respiratory syndrome-coronavirus 2 pandemic. Although diagnostic criteria of MIS-C have now been established to raise the clinical suspicion for the condition, the Kawasaki disease (KD)-like phenotype of MIS-C presents with additional therapeutic dilemmas. The treatment guidance till date remains empirical with consideration of intravenous immunoglobulin (IVIG) and glucocorticoids. However, treatment of cases refractory to the current conventional therapy with respect to biologics remains uncertain. We describe here, an 8-year-old boy with MIS-C (KD-like phenotype) with severe cardiac dysfunction refractory to IVIG and pulse methylprednisolone who responded to tumor necrosis factor-α inhibition using infliximab.