The Great Gut Mimicker: A case report of MIS-C and appendicitis clinical presentation overlap in a teenage patient

Hwang, Michelle S.; Wilson, Kelsey; Wendt, Lisa; Pohlman, Joshua; Densmore, Emily M.; Kaeppler, Caitlin; Arendonk, Kyle J. Van; Yale, Sarah

doi:10.1186/s12887-021-02724-x

Cited by 26 publications

(29 citation statements)

References 20 publications

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“…These GI symptoms may mimic many infectious or inflammatory etiologies or, as in our case, require surgical intervention for suspected acute appendicitis. A recent case report describes MIS-C presenting with signs and symptoms of appendicitis; however, this case patient also met MIS-C criteria on presentation [3]. Fever is the key diagnostic criteria in MIS-C as evidenced by a large Lancet review of 662 patients, with 100% of patients presenting with fever and a mean duration of fever before the presentation of 4.8 days [4].…”

Section: Discussionmentioning

confidence: 81%

Multisystem Inflammatory Syndrome Presenting as Early Acute Appendicitis

Anderson¹,

Bhisitkul²,

Pham³

et al. 2021

Cureus

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An 11-year-old male presented to the pediatric emergency department with a one-day history of periumbilical pain with nausea, anorexia, and scant vomiting. On examination, he had moderate tenderness in the right upper quadrant with moderate guarding and rebound tenderness. Imaging showed concern for early acute appendicitis. The patient was admitted and underwent laparoscopic appendectomy. Despite the appendectomy, the patient continued to have fevers and abdominal pain. Four days after the initial presentation, the patient decompensated and was diagnosed with multisystem inflammatory syndrome. This case is interesting because the patient never met diagnostic criteria for multisystem inflammatory syndrome in children (MIS-C) prior to his decompensation. If a patient's symptoms continue or worsen despite seemingly appropriate management, the patient must be reassessed for other causes of pathology. Surgeons must have a high index of suspicion for MIS-C in patients with recent COVID-19 diagnoses, and this case demonstrates that MIS-C can present in phases and not all at once.

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Section: Discussionmentioning

confidence: 81%

Multisystem Inflammatory Syndrome Presenting as Early Acute Appendicitis

Anderson¹,

Bhisitkul²,

Pham³

et al. 2021

Cureus

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“…Additionally, MIS may be accompanied by prominent gastrointestinal symptoms [ 46 ], a common feature of this syndrome in children, and can overlap with infectious or inflammatory abdominal conditions [ 47 ]. Furthermore, MIS may be accompanied by syncope, increased troponin levels, thrombocytopenia, lymphopenia, abnormal echocardiography findings (myocarditis, valvulitis, pericardial effusion, and coronary artery dilatation), abnormal abdominal ultrasonography findings (lymphadenopathy), and anemia [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Adverse Events and Safety Profile of the COVID-19 Vaccines in Adolescents: Safety Monitoring for Adverse Events Using Real-World Data

Lee

Hong

et al. 2022

Vaccines

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A COVID-19 vaccine BNT162b2 (Pfizer-BioNTech) has recently been authorized for adolescents in the US. However, the impact of adverse events on adolescents after vaccination has not been fully investigated. To assess the safety of the COVID-19 vaccine in adolescents, the incidence of adverse events (AEs) in adolescents and adults was compared after vaccination. We included 6304 adolescents (68.14 per 100,000 people) who reported adverse events using vaccine adverse event reporting system (VAERS) data from 10 May 2021 to 30 September 2021. The mean age was 13.6 ± 1.1 years and women (52.7%) outnumbered men. We analyzed severe and common adverse events in response to the COVID-19 vaccine among 6304 adolescents (68.14 per 100,000 people; 52% female; mean age, 13.6 ± 1.1 years). The risk of myocarditis or pericarditis among adolescents was significantly higher in men than in women (OR = 6.61, 95% CI = 4.43 to 9.88; p < 0.001), with a higher frequency after the second dose of the vaccine (OR = 8.52, 95% CI = 5.79 to 12.54; p < 0.001). In addition, severe adverse events such as multisystem inflammatory syndromes, where the incidence rate per 100,000 people was 0.11 (n = 10), and the relative risk was 244.3 (95% CI = 31.27 to 1908.38; p < 0.001), were significantly higher in adolescents than in adults. The risk of the inflammatory response to the COVID-19 vaccine, including myocarditis, pericarditis, or multisystem inflammatory syndromes, was significantly higher in men than in women, with a higher frequency in adolescents than in adults. The inflammation-related AEs may require close monitoring and management in adolescents.

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“…In our case, there were laparoscopic signs of pelvioperitonitis without signs of acute appendicitis, so we considered it unnecessary to perform appendectomy, although a similar case with this “abdominal form” of MIS-C and negative appendectomy was described by Hwang M. et al A 16-year-old female [ 1 ] presented with a four-day history of abdominal pain, vomiting, fever, and positive IgG for SARS-CoV-2 on admission, underwent laparoscopic appendectomy on the second day in hospital as she reported increased pain in the right lower quadrant and demonstrated new abdominal rebound tenderness in the abdominal region despite the empiric treatment of appendicitis with piperacillin tazobactam. The postoperative period, after the completion of immunoglobulin therapy, revealed a deterioration in the patient's condition, resembling a relapse of MIS-C, and corticosteroid therapy and hemodynamic support within 24 hours were successfully applied.…”

Section: Discussionmentioning

confidence: 78%

“…Multisystem inflammatory syndrome in children can mimic [ 1 , 2 ] and/or provoke acute abdominal diseases: intestinal intussusception/obstruction [ 3 ], terminal ileitis and/or colitis [ 4 ], internal hernia, necrotizing mesenteric lymphadenitis, acute appendicitis [ [5] , [6] , [7] ]and intestinal perforation [ 8 ], which can lead to a life-threatening condition called “inflammatory peritonitis” [ 9 ] and, as a result, an inflammatory syndrome that resembles septic shock, or, in some cases, septic shock itself (see Fig. 1 ).…”

Section: Introductionmentioning

confidence: 99%

Emergency diagnostic laparoscopy for multisystem inflammatory syndrome in a child

Panko¹,

Panko²,

Pan’ko

et al. 2022

Journal of Pediatric Surgery Case Reports

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COVID-19 and multisystem inflammatory syndrome in children (MIS-C) can mimic and cause acute abdominal diseases such as intestinal obstruction, terminal ileitis, colitis, internal necrotizing mesenteric lymphadenitis, acute appendicitis, and sometimes bowel perforation. We report a case of a 6-year-old female with MIS-C and acute purulent pelviperitonitis, who was successfully treated by laparoscopy and an antibiotic without intravenous immunoglobulin and aspirin therapy. We believe that the case description should help to find a worthy place for early laparoscopic and other minimally invasive procedures for the management of similar MIS-C cases.

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The Great Gut Mimicker: A case report of MIS-C and appendicitis clinical presentation overlap in a teenage patient

Cited by 26 publications

References 20 publications

Multisystem Inflammatory Syndrome Presenting as Early Acute Appendicitis

Multisystem Inflammatory Syndrome Presenting as Early Acute Appendicitis

Adverse Events and Safety Profile of the COVID-19 Vaccines in Adolescents: Safety Monitoring for Adverse Events Using Real-World Data

Emergency diagnostic laparoscopy for multisystem inflammatory syndrome in a child

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