Abstract
Introduction: While the clinical course of SARS-CoV-2 infection seems to be milder or asymptomatic within the pediatric population, growing attention has been laid to the rare complication elicited by virus, multisystem inflammatory syndrome in children temporarily associated with COVID-19 (MIS-C). Published definition and criteria of MIS-C include persistent fever, multisystem involvement, and elevated markers of inflammation, without obvious microbial inflammation or other plausible diagnosis. However, the aim of this case report is to emphasize the diversity of symptoms of MIS-C, beyond the defined criteria.Case Presentation: We present a 10-year-old boy with 8p23.1 microdeletion syndrome and multiple comorbidities who initially came to our attention due to hematuria, persistent fever, rash, and elevated markers of inflammation. Within the next 2 days, his condition worsened despite the broad-spectrum antibiotic therapy. Assuming his past history of SARS-CoV-2 exposure, MIS-C was suspected. A high level of clinical suspicion was further supported by significant clinical features (vomiting, abdominal pain, conjunctivitis, arrhythmia, and mild left ventricular systolic dysfunction with pleural effusion) along with laboratory findings (elevated ESR, CRP, proBNP, D-dimers and fibrinogen, positive IgG SARS-CoV-2 antibodies, and negative microbiological cultures). The patient was given intravenous immunoglobulin (IVIG) and began to show instantaneous clinical and laboratory improvement.Conclusion: Despite numerous reports of MIS-C cases in children, there are still many uncertainties regarding the clinical presentation and laboratory findings, as well as mechanisms beyond this intriguing disorder. In our case, for the first time hematuria is reported as an early symptom of MIS-C. We strongly believe that reporting various manifestations and outcomes in MIS-C patients will lead to improved diagnosis, treatment, and overall understanding of this novel inflammatory condition.
Highlights
While the clinical course of SARS-CoV-2 infection seems to be milder or asymptomatic within the pediatric population, growing attention has been laid to the rare complication elicited by virus, multisystem inflammatory syndrome in children temporarily associated with COVID-19 (MIS-C)
The first experience from the beginning of the COVID-19 pandemic showed that children rarely developed severe or critical illness [1] or die from the infection as compared with adults [2, 3]
With continued pandemic and increasing awareness of this syndrome among clinicians, it is expected that more cases of MIS-C will be diagnosed and unusual presentations are likely to be seen, while, on the other hand, extensive medical and public attention might result in overdiagnosis of MIS-C, which highlights the need for reporting informative cases [32]
Summary
While the clinical course of SARS-CoV-2 infection seems to be milder or asymptomatic within the pediatric population, growing attention has been laid to the rare complication elicited by virus, multisystem inflammatory syndrome in children temporarily associated with COVID-19 (MIS-C). Since the beginning of the pandemic, multisystem inflammatory syndrome in children (MIS-C), a new phenomenon with temporal association with COVID19, has become a great concern of parents and pediatricians worldwide [4,5,6]. We describe an unusual case of a boy who initially presented with hematuria, persistent fever, rash, and elevated markers of inflammation, while, within the 2 days he developed multisystem involvement and met the criteria for MISC. We performed a literature review of MIS-C patients presenting with renal symptoms The aim of this case report is to emphasize the diversity of symptoms of MIS-C, beyond the defined criteria
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