Hematuria as an Early Sign of Multisystem Inflammatory Syndrome in Children: A Case Report of a Boy With Multiple Comorbidities and Review of Literature

Abstract

Introduction: While the clinical course of SARS-CoV-2 infection seems to be milder or asymptomatic within the pediatric population, growing attention has been laid to the rare complication elicited by virus, multisystem inflammatory syndrome in children temporarily associated with COVID-19 (MIS-C). Published definition and criteria of MIS-C include persistent fever, multisystem involvement, and elevated markers of inflammation, without obvious microbial inflammation or other plausible diagnosis. However, the aim of this case report is to emphasize the diversity of symptoms of MIS-C, beyond the defined criteria.Case Presentation: We present a 10-year-old boy with 8p23.1 microdeletion syndrome and multiple comorbidities who initially came to our attention due to hematuria, persistent fever, rash, and elevated markers of inflammation. Within the next 2 days, his condition worsened despite the broad-spectrum antibiotic therapy. Assuming his past history of SARS-CoV-2 exposure, MIS-C was suspected. A high level of clinical suspicion was further supported by significant clinical features (vomiting, abdominal pain, conjunctivitis, arrhythmia, and mild left ventricular systolic dysfunction with pleural effusion) along with laboratory findings (elevated ESR, CRP, proBNP, D-dimers and fibrinogen, positive IgG SARS-CoV-2 antibodies, and negative microbiological cultures). The patient was given intravenous immunoglobulin (IVIG) and began to show instantaneous clinical and laboratory improvement.Conclusion: Despite numerous reports of MIS-C cases in children, there are still many uncertainties regarding the clinical presentation and laboratory findings, as well as mechanisms beyond this intriguing disorder. In our case, for the first time hematuria is reported as an early symptom of MIS-C. We strongly believe that reporting various manifestations and outcomes in MIS-C patients will lead to improved diagnosis, treatment, and overall understanding of this novel inflammatory condition.

Neurological Involvement in Multisystem Inflammatory Syndrome in Children: Clinical, Electroencephalographic and Magnetic Resonance Imaging Peculiarities and Therapeutic Implications. An Italian Single-Center Experience

“…Generally speaking, while the onset of MISC observed in our study resembled the onset symptoms described in cases reported in the literature, the clinical evolution of our patients was found to be relatively favorable (17). Early multidisciplinary diagnosis and the immediate use of immunomodulatory and anticoagulant therapies, as well as the inotropic support given to patients with severe cardiac dysfunction or with capillary leaks, certainly played a role in preventing other organ damage, such as AKI (26).…”

Well-known symptoms, new disease – a case of SARS-CoV-2 infection in an eight-year-old boy

“…It is worth underlying that the literature also provides cases of PIMS-TS with haematuria as an early sign of the disease [12] or diarrhoea and fever as the only symptoms presented by the patient [13]. Those cases confirm the need for the conduction of an extended diagnostic process for each child reporting to the hospital, even when the symptoms are not characteristic and specific for PIMS-TS.…”

“…PIMS-TS should be differentiated with many paediatric conditions, such as Kawasaki disease, rheumatic fever, or appendicitis (more information in Table 3) [10][11][12][13][14][15].…”

Commentary: Hematuria as an early sign of multisystem inflammatory syndrome in children: A case report of a boy with multiple comorbidities and a review of the literature

“…Cardiovascular MRI should have been at least considered, even though direct tissue examination remains the diagnostic reference standard. The indirect statement in the article that thrombocyte levels can rule out Kawasaki disease at “day 7” is also misleading, as thrombocytosis in Kawasaki disease is often seen in the second or third week of illness ( 1 , 14 ).…”

“…Recently, we encountered an article that describes hematuria as the early onset of multisystem inflammatory syndrome in children (MIS-C) ( 1 ). Upon further analysis, we found some inconsistencies in the commented article, which we outlined in the following article.…”