Multisystem inflammatory syndrome in children-associated with severe acute respiratory syndrome coronavirus 2: A case report and brief review of literature

Abstract

, more than 25.1 million confirmed cases of coronavirus disease (COVID-19) including more than 844,000 deaths have been reported worldwide [1]. Limited data describe clinical manifestations of COVID-19 generally milder in children compared with adults but also show that some children do require hospitalization and intensive care support. Recently, a limited number of children with exposure to COVID-19 virus who developed significant systemic inflammatory response syndrome with clinical features overlapping with Kawasaki disease (KD) and toxic shock syndrome have been identified from Europe, North America, and various parts of the world [2]. This syndrome has been described in children after 2-4 weeks of exposure to COVID-19 virus suggesting aberrant cellular and humoral immune response to the virus [3]. This syndrome has been labeled by different terminologies such as multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [4], pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIM-TS) [5], and hyperinflammatory shock during COVID-19 pandemic [6]. Clinical and laboratory manifestations of MIS-C have been attributed to the antibodies produced against SARS-CoV-2. It has been postulated that these antibodies enhance the severity of infection by triggering inflammation or mediating organ damage [3]. Clinical similarity between KD and MIS-C implies a related underlying genetic architecture, supporting the hypothesis that the new disorder arises from aberrant T-or B-cell responses to SARS-CoV-2 [7]. MIS-C shares overlapping clinical features with KD such as conjunctival injection, oropharyngeal findings (red and/ or cracked lips and strawberry tongue), rash, swollen and/or erythematous hands and feet, and cervical lymphadenopathy. However, some notable differences from KD include broader age range of presentation, more prominent gastrointestinal and neurological symptoms, more frequent presentation with shock, and more likely to display cardiac dysfunction (arrhythmias and ventricular dysfunction) [8]. Here, we report a case of a previously well 4-year-old female child who presented to us with MIS-C following exposure to SARS-CoV-2 and was successfully managed with intravenous immunoglobulin (IVIG) and intravenous (IV) steroids. CASE REPORT A 4-year-old female child who was previously well was brought with complaints of high-grade fever (>39°C), vomiting, and loose motions for 4 days. She developed a non-itchy, generalized rash all over the body 2 days before admission. It initially started