Abstract
A novel coronavirus was identified in late 2019 that rapidly reached pandemic proportions. The World Health Organization has designated the disease as COVID-19, which stands for coronavirus disease 2019. In children, COVID-19 is usually mild. However, in rare cases, children can be severely affected, and clinical manifestations may differ from adults. In April of 2020, reports from the United Kingdom documented a presentation in children similar to incomplete Kawasaki disease (KD) or toxic shock syndrome. Since then, there have been reports of similarly affected children in other parts of the world. The condition has been termed multisystem inflammatory syndrome in children (MIS-C). We report a case of a 12-year-old previously healthy boy admitted with fever, generalized skin rash, conjunctivitis, and multiorgan dysfunction with positive COVID-19 polymerase chain reaction (PCR), and diagnosed as MIS-C on the basis of clinical and laboratory criteria. He received intravenous immunoglobulin (IVIG) for two days and other supportive treatment. He improved with defervescence and normalization of acute-phase reactants.
Highlights
Children with coronavirus disease 2019 (COVID-19) usually present with relatively mild symptoms
In the Spring of 2020, case reports emerged from the United Kingdom and neighboring countries which described an illness like Kawasaki disease (KD) in children and adolescents related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection
Most affected children showed a positive serology for SARS-CoV-2 with negative polymerase chain reaction (PCR), a finding that further supports the hypothesis that multisystem inflammatory syndrome in children (MIS-C) is related to immune dysregulation occurring after acute infection has passed
Summary
Children with coronavirus disease 2019 (COVID-19) usually present with relatively mild symptoms. He was admitted to the pediatric medical ward (in an isolation room) with a provisional diagnosis of nonspecific viral exanthema His initial blood workup and COVID PCR were taken and he was started on antipyretics and intravenous fluids to address fever and hydration. With 48 hours of admission, he started complaining of palpitations and mild chest pain and his blood pressure dropped to 5th centile for his height and age without any fluid loss As his clinical features and laboratory values fulfilled the criteria for MIS-C (American college of Rheumatology) with a link to COVID 19, treatment was planned. SARS-CoV-2: severe acute respiratory syndrome coronavirus 2; MIS-C: multisystem inflammatory syndrome in children; CBC: complete blood count; CMP: comprehensive metabolic panel; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; PCR: polymerase chain reaction; ALC: absolute lymphocyte count; PT: prothrombin time; PTT: partial thromboplastin time; LDH: lactate dehydrogenase. MIS-C: multisystem inflammatory syndrome in children; IVIG: intravenous immunoglobulin
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