Clinical features of multisystem inflammatory syndrome in children challenges for clinicians: a case report

Authors

  • Natallia Vasileuna Matsiyeuskaya Department of Infectious Diseases, Grodno State Medical University, Grodno, Belarus
  • Mehul Hitesh Sadadiwala Department of Infectious Diseases, Grodno State Medical University, Grodno, Belarus
  • Grishma Rajendrakumar Patel Department of Infectious Diseases, Grodno State Medical University, Grodno, Belarus
  • Jabir Rafique Mistry Department of Infectious Diseases, Grodno State Medical University, Grodno, Belarus
  • Aleksandra Leonidovna Potapchik Department of Infectious Diseases, Grodno State Medical University, Grodno, Belarus

DOI:

https://doi.org/10.18203/2320-6012.ijrms20232801

Keywords:

Multisystem inflammatory syndrome in children, SARS-CoV-2 hyperinflammatory syndrome, KD

Abstract

A variety of complications came to light after the SARS-CoV-2 pandemic of 2020. One such post-covid complication that manifests itself in the form of a hyperinflammatory syndrome in the pediatric population is multisystem inflammatory syndrome in children (MIS-C). It results in severe inflammation of a variety of organ systems, including the heart, lungs, brain, kidneys, gastrointestinal system, skin, and eyes. Surprisingly, clinicians can easily mistake this type of presentation for many other diseases due to overlapping features, especially Kawasaki disease (KD). An interesting case report on a patient admitted to the Grodno regional infectious diseases clinical hospital, Grodno, Belarus. The patient was initially diagnosed with enteroviral infection (EVI) at the time of admission. The clinicians in charge observed the underlying cause to be masked by Kawasaki-like presentation, how they diagnosed MIS-C, Kawasaki-like phenotype: exanthema, cheilitis, scleritis, infectious cardiopathy, gastrointestinal syndrome, coagulopathy and managed this patient is described in this scientific paper. Although the presenting signs and symptoms of MIS-C overlap with other diseases, certain additional features can be helpful in differentiation. Mainly MIS-C is present in a relatively older subgroup along with gastrointestinal symptoms that are uncommon for KD. The patient was treated with IVIG and steroids after which he attained full recovery. MIS-C associated with COVID-19 is serious, rare, and potentially fatal. Clinicians, primary care physicians, and emergency department pediatricians must be quick to recognize it and treat it at the earliest by deploying immunomodulatory strategies to subdue systemic injury caused by hyper-inflammation.

 

References

Ludvigsson JF. Systematic review of COVID‐19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109(6):1088-95.

Gottlieb M, Bridwell R, Ravera J, Long B. Multisystem inflammatory syndrome in children with COVID-19. Am J Emerg Med. 2021;49:148-52.

Jayaseelan K, Frishman WH. Multisystem Inflammatory Syndrome. Cardiol Rev. 2023;31(2):61-4.

Health department-reported cases of multisystem inflammatory syndrome in children (MIS-C) in the United States. Centers for Disease Control and Prevention. 2023.

Kabeerdoss J, Pilania RK, Karkhele R, Kumar TS, Danda D, Singh S. Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management. Rheumatol Int. 2021;41(1):19-32.

Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA. 2020;324(3):259-69.

Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395(10237):1607-8.

Loke YH, Berul CI, Harahsheh AS. Multisystem inflammatory syndrome in children: Is there a linkage to Kawasaki disease? Trends Cardiovasc Med. 2020;30(7):389-96.

McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, treatment, and long-term management of kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017;135(17):927-99.

Abrams JY, Godfred-Cato SE, Oster ME, Chow EJ, Koumans EH, Bryant B, et al. Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2: a systematic review. J Pediatr. 2020;226:45-54.

Ouldali N, Pouletty M, Mariani P, Beyler C, Blachier A, Bonacorsi S, et al. Emergence of Kawasaki disease related to SARS-CoV-2 infection in an epicentre of the French COVID-19 epidemic: a time-series analysis. Lancet Child Adolesc Health. 2020;4(9):662-8.

Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, et al. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med. 2020;383(4):347-58.

Sadadiwala MH. Characteristic of cardiac and neurological forms of non-polio enterovirus infection. Int J Adv Med. 2022;9:1230.

Jain S, Patel B, Bhatt GC. Enteroviral encephalitis in children: clinical features, pathophysiology, and treatment advances. Pathog Glob Health. 2014;108(5):216-22.

Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, et al. American College of rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS–CoV‐2 and hyperinflammation in pediatric COVID‐19: Version 1. Arthritis Rheumatol. 2020;72(11):1791-805.

Kaushik A, Gupta S, Sood M, Sharma S, Verma S. A systematic review of multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection. Pediatr Infect Dis J. 2020;39(11):340-6.

Zhu YP, Shamie I, Lee JC, Nowell CJ, Peng W, Angulo S, et al. Immune response to intravenous immunoglobulin in patients with Kawasaki disease and MIS-C. J Clin Invest. 2021;131(20):147076.

Panda PK, Sharawat IK, Natarajan V, Bhakat R, Panda P, Dawman L. COVID-19 treatment in children: A systematic review and meta-analysis. J Family Med Prim Care. 2021;10(9):3292-302.

El-Chaar, G. Pharmacotherapy of acute COVID-19 infection and multisystem inflammatory syndrome in children: current state of knowledge. Pediatr Allergy Immunol Pulmonol. 2020;33(4):177-89.

Ouldali N, Toubiana J, Antona D, Javouhey E, Madhi F, Lorrot M, et al. Association of intravenous immunoglobulins plus methylprednisolone vs immunoglobulins alone with course of fever in multisystem inflammatory syndrome in children. JAMA. 2021;325(9):855-64.

Zambrano LD, Newhams MM, Olson SM, Halasa NB, Price AM, Boom JA, et al. Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA vaccination against multisystem inflammatory syndrome in children among persons aged 12-18 years-United States, July–December 2021. MMWR Morb Mortal Wkly Rep. 2022;71(2):52-8.

Nygaard U, Holm M, Hartling UB, Glenthøj J, Schmidt LS, Nordly SB, et al. Incidence and clinical phenotype of multisystem inflammatory syndrome in children after infection with the SARS-CoV-2 delta variant by vaccination status: a Danish nationwide prospective cohort study. Lancet Child Adolesc Health. 2022;6(7):459-65.

Davies P, Evans C, Kanthimathinathan HK, Lillie J, Brierley J, Waters G, et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health. 2020;4(9):669-77.

Bautista-Rodriguez C, Sanchez-de-Toledo J, Clark BC, Herberg J, Bajolle F, Randanne PC, et al. Multisystem inflammatory syndrome in children: an international survey. Pediatrics. 2021;147(2):e2020024554.

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Published

2023-08-31

How to Cite

Matsiyeuskaya, N. V., Sadadiwala, M. H., Patel, G. R., Mistry, J. R., & Potapchik , A. L. (2023). Clinical features of multisystem inflammatory syndrome in children challenges for clinicians: a case report . International Journal of Research in Medical Sciences, 11(9), 3422–3427. https://doi.org/10.18203/2320-6012.ijrms20232801

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Section

Case Reports