Objective: This study aimed to evaluate the effectiveness and optimal use of corticosteroids in children with severe coronavirus disease 2019 (COVID-19) pneumonia. Methods: We conducted a retrospective study and included patients (aged<18 years) with severe COVID-19 pneumonia and/or acute respiratory distress syndrome (ARDS) who received standard doses (2–4 mg/kg/day) and high doses (>250 mg/day) of methylprednisolone (MPZ). We adjusted for patients on steroid treatments with a propensity score and patient survival. Results: Fifty-nine patients were included: 61% were male, the median age was 8 (interquartile range [IQR], 2–15) years. The overall survival was 84.4% in patients treated with standard-dose MPZ (n = 45, 76.3%) and 92.2% in patients treated with high-dose MPZ (n = 14, 23.7%; p = 0.67). The demographic, clinical, and laboratory data didn’t differ significantly after propensity score matching, apart from bradycardia, which was a prominent feature of the high-dose group. The clinical and radiological response rates on Day 7 were higher and the need for invasive mechanical ventilation (IMV) was lower in the high-dose group. Conclusion: Pulse MPZ treatment seems to result in better clinical and radiological responses, with less need for IMV, although the mortality rate doesn’t differ between standard and high-dose regimens of MPZ.

Multisystem inflammatory syndrome in children (MIS-C) is a serious disease with different and various clinical presentations. We may define it as a “game changer” syndrome. Individual clinical entity is seen in each patient and challenge clinicians. We have seen that patients with perforated appendicitis findings on physical examinations who may require urgent surgery recover with steroids or immunomodulators. Treatment must be tailored to each patient individually. Here, we will present three children with a diagnosis of MIS-C who have hemophagocytosis in bone marrow aspiration, which are clinically suggestive of secondary hemophagocytic lympho-histiocytosis (HLH).