Abstract
the new coronavirus pandemic has been a reality throughout 2020, and it has brought great challenges. The virus predominantly manifests in the pediatric population with mild symptoms. However, an increase in the incidence of Multisystemic Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 has been described in the literature. MIS-C manifests mainly with fever and gastrointestinal symptoms and may mimic acute abdomen due to acute appendicitis. The objective of this study is to propose a care flowchart for suspected cases of acute appendicitis in the initial phase in pandemic times, considering the possibility of MIS-C. This situation was brought up by a patient treated in a pediatric hospital in Brazil. It was possible to identify common signs and symptoms in the reported patient and those published cases that may serve as alerts for early identification of MIS-C cases. Based on the literature review and on the similarities between the syndrome and the inflammatory acute abdomen in children, we elaborated an initial approach for these cases to facilitate the identification, early diagnosis, and management. The flowchart considers details of the clinical history, physical examination, and complementary exams prior to the indication of appendectomy in patients with initial phase symptoms. MIS-C, although rare and of poorly known pathophysiology, is most often severe and has a high mortality risk. The use of the proposed flowchart can help in the diagnosis and early treatment of MIS-C.
Highlights
The pandemic of the new coronavirus has been a reality throughout 2020 and brought many challenges with it
The same has been described in other countries as Multisystem Inflammatory Syndrome in Children (MIS-C) or Pediatric Multisystem Inflammatory Syndrome (PMIS), which became part of the COVID-19 clinical manifestations spectrum[3,4,5,6,7,8,9,10]
The motivation for this study is the case of a patient attended at the Hospital Pequeno Príncipe, Curitiba, Parana State, Brazil, with diagnosis of COVID-19 associated Multisystem Inflammatory Syndrome, who had initial diagnosis and treatment of acute appendicitis, and is reported
Summary
The pandemic of the new coronavirus has been a reality throughout 2020 and brought many challenges with it. In April of 2020 an increase in the incidence of Kawasaki like Syndrome and hyperinflammatory shock was reported in England, with potential association to COVID-191,2. The same has been described in other countries as Multisystem Inflammatory Syndrome in Children (MIS-C) or Pediatric Multisystem Inflammatory Syndrome (PMIS), which became part of the COVID-19 clinical manifestations spectrum[3,4,5,6,7,8,9,10]. MIS-C includes a hyperimmune inflammatory phase, whose main signs and symptoms are fever and gastrointestinal manifestations and may simulate acute abdomen due to acute appendicitis in children[11]. Considering the high incidence of acute appendicitis as cause of acute abdomen in pediatric
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