BACKGROUND: Italy was the first Western country to be hit by the SARS-CoV-2 epidemic . There is now mounting evidence that a minority of children infected with SARS-CoV2 may experience a severe multisystem inflammatory syndrome, called Multisystem inflammatory Syndrome associated with Coronavirus Disease 2019 (MIS-C). To date no universally agreed approach is available for this disease . MAIN BODY: as Italy is now facing a second hity of COVID-19 cases, we fear a recrudescence of MIS-C cases . We have, therefore, decided to prepare a report that will help clinicians to face this novel and challenging disease . We propose a diagnostic algorithm, to help case definition and guide work-up, and a therapeutic approach . MIS-C should be promptly recognized, based on the presence of systemic inflammation and specific organ involvement . Early treatment is crucial, and it will be based on the combined use of corticosteroids, high-dose immunoglobulins and anti-cytokine treatments, depending on the severity of the disease . Ancillary treatments (such as . aspirin and thrombo-profilaxis) will be also discussed .

CONCLUSIONS: we propose a document that will help physicians to diagnose and treat MIS-C patients . Given the level of evidence available and the methodology used, this document should not be interpreted as a guideline; the final decision about the optimal management should still be taken by the caring physician, on an individual basis.