Tocilizumab: therapeutic alternative for pediatric multisystemic inflammatory syndrome

Pediatric inflammatory multisystem syndrome (PIMS-TS) temporally associated with coronavirus disease 2019 (COVID-19) and inflammatory syndrome in children (MIS-C) is a novel hyperinflammatory condition that shares features with Kawasaki disease and toxic shock syndrome. We report a 4-year-old male patient who presented with fever for 5 days, abdominal pain, vomiting, conjunctivitis, and dermatosis. He had close contact with a case of COVID-19 four weeks prior to presentation. On physical exam he was irritable, had palpebral edema, conjunctivitis, hyperemic pharynx, cervical lymphadenopathy, palmar erythema, and was in shock. The diagnosis of PIMS temporally associated with COVID-19 was established according to the Centers for Disease Control and Prevention criteria. He was admitted to the pediatric intensive care unit, where he received immunoglobulin and steroids. Due to refractoriness to the initial treatment, tocilizumab was administered, with adequate response. This case demonstrates the effectiveness of the use of tocilizumab as a therapeutic alternative in the case of refractoriness to the first line therapy. Further studies are required to understand the pathophysiological mechanisms and response to different therapeutic options.