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Cyclosporine for the treatment of multisystem inflammatory syndrome in children with coronary artery aneurysms
  1. Tomohiro Hiraoka1,
  2. Mitsuru Tsuge2 and
  3. Yoichi Kondo1
  1. 1Paediatrics, Matsuyama Red Cross Hospital, Matsuyama, Japan
  2. 2Department of Paediatric Acute Diseases, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University Hospital, Okayama, Japan
  1. Correspondence to Dr Tomohiro Hiraoka; tomohiro.hiraoka{at}


Multisystem inflammatory syndrome in children (MIS-C) is a newly described syndrome related to the COVID-19, resembling other known aetiologies, including Kawasaki disease. Cardiovascular involvement is common; left ventricle dysfunction and coronary artery aneurysm (CAA) are also observed. Many treatment guidelines recommend using intravenous immunoglobulin (IVIG) alone or with glucocorticoids as the first-line therapy. Biological agents, such as anakinra, are recommended for refractory cases, but the evidence is still accumulating. Moreover, the use of other treatment agents can be beneficial, especially when anakinra is unavailable. Here, we report the case of a 9-year-old girl who presented with MIS-C with CAAs. She received cyclosporine because two rounds of IVIG treatment were ineffective and the use of anakinra is not approved in Japan. Her cytokine profile showed that cyclosporine prevented exacerbation. The case highlights that cyclosporine therapy can be an option for the treatment of refractory MIS-C with CAA.

  • COVID-19
  • Infections
  • Paediatrics (drugs and medicines)
  • Infectious diseases

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  • Contributors TH wrote the manuscript. MT measured cytokine profiles and critically revised the manuscript. YK supervised and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.