The Challenging Diagnosis of Pediatric Multisystem Inflammatory Syndrome Associated with Sars-Cov-2 Infection-Two Case Reports and Literature Review

Abstract

Severe acute respiratory coronavirus 2 (SARS-CoV-2) is a novel coronavirus discovered in 2019 that caused the coronavirus disease 2019 (COVID19). During the last year, over 70 million people were infected and more than 1.5 million people died. Despite the tremendous number of people infected, children were less affected and presented milder forms of the disease. A short time after the pandemic was declared, a new hyperinflammatory syndrome resembling Kawasaki disease (KD) was described in children with confirmed or suspected SARS-CoV-2 infection named multisystem inflammatory syndrome in children (MIS-C). The incidence of MIS-C is low and it has a polymorphous clinical presentation, making the diagnosis difficult. Although the incidence is reduced, there is a high risk of cardiovascular complications. In order to raise awareness, we present the cases of two pediatric patients diagnosed with MIS-C in our clinic.

MIS-C related to SARS-CoV-2 infection: a narrative review of presentation, differential diagnosis, and management

“…Physical examination revealed pharyngeal erythema [41,46], tonsillar exudates [46]. Mucocutaneous findings were observed, including a blanchable maculopapular rash on palms and soles [6, 8, 9, 30, 40, 41, 43, 45, 47-51, 54-56, 58, 60, 61, 63, 66, 67], conjunctivitis [8, 9, 29, 30, 40, 43-50, 56, 58, 60, 63, 67], mucositis [49,56,66], lip swelling [30,40,50,56], strawberry tongue [45], periungal peeling [42], swelling of hands, feet, [9, 29,44,47,[49][50]56] and eyelids (periorbital edema) [44,45] and pain in the extremities [41,44,47,63], these being consistent with features of KD. Prominent GI symptoms were seen, such as vomiting [8-9, 30, 40, 42-44, 49-51, 56, 59, 60, 62, 63], abdominal pain [6, 8, 9, 30, 40, 41-44, 46-49, 52, 53, 56, 58-60, 62, 63, 68], diarrhea [8, 9, 30, 40, 42-44, 46, 48, 49, 53, 56, 59, 60, 62, 63], mild abdominal distension [69], and anorexia [44].…”

“…Mortality was seen in 14 patients with COVID-19 related neurological involvement [72]. Many of the cases studied took a turn for the worse, with signs and symptoms of prolonged inflammation [40], tachycardia [9, 30,44,46,47,50,57,63], bradycardia [67] with conduction abnormalities [67,73], hypotension [9, 43,44,64,67], somnolence [50,51], hypotonia [51], hypoxia [48,67], respiratory failure [54] and shock [6, 30,40,43,48,54,56], with admission to the intensive unit care [48,50]. In many, the symptoms were very similar to those of KD [6, 29,30,41,[44][45][46]48 [42,43,47,72], TSS [41,49,67,68], cytokine storm, HLH, [41] septic shock…”

“…Primary laboratory tests included positive COVID RT-PCR test [6,8,9,40,41,48,51,53,[56][57][58]70], and positive SARS-CoV-2 antibody test [30,44,48,50,51,53,55,58,59,60,68,69,73]. Cases also involved intracranial pressure [53].…”

SARS-CoV-2-Associated Multisystem Inflammatory Syndrome in a Child in Uganda: A Paediatric Experience in a Resource-Limited Setting

“…MIS-C associated with SARS-CoV-2 is a rare (2 in 100,000) severe clinical presentation of COVID-19 in children [ 9 , 13 ]. Although it is rare, there is a need to raise awareness of this syndrome due to its diverse presentation, the emergency/critical care needed, and the possible fatal complications.…”

“…MIS-C diagnosis can be difficult due to its diverse presentation [ 3 , 9 ]. Furthermore, there is still limited knowledge and experience in the diagnosis and management of SARS-CoV-2-associated MIS-C among clinicians in a resource-limited setting (RLS).…”