Abstract
BackgroundAdolescents with coronavirus disease 2019 (COVID-19) associated multisystem inflammatory syndrome (MIS) can present with shock and myocardial injury and mimic Kawasaki disease.Case presentationWe describe 4 previously well adolescents (age 13–14 years), presenting with clinical features of MIS in children (MIS-C). All patients had nearly similar clinical presentation. Hematological investigations revealed elevated inflammatory markers, anemia, thrombocytopenia, and decreased neutrophil:lymphocyte ratio. All patients were negative on real-time polymerase chain reaction against severe acute respiratory syndrome coronavirus 2, but had elevated immunoglobulin G titers. Two patients had atypical Kawasaki disease. Three patients had severe disease with hypotensive shock and required intensive care with fluids and inotropes. Two patients required non-invasive respiratory support for dyspnea and one patient had biventricular dysfunction. All received empiric antibiotics, low-molecular weight heparin, steroids, and intravenous immunoglobulin. One patient succumbed, while others recovered well.ConclusionsMIS-C may be a late presentation in adolescent with COVID-19. Individualized treatment with empiric antibiotics, immunomodulation, and thromboprophylaxis can result in significantly better outcome.
Highlights
Adolescents with coronavirus disease 2019 (COVID-19) associated multisystem inflammatory syndrome (MIS) can present with shock and myocardial injury and mimic Kawasaki disease.Case presentation: We describe 4 previously well adolescents, presenting with clinical features of MIS in children (MIS-C)
MIS-C may be a late presentation in adolescent with COVID-19
Individualized treatment with empiric antibiotics, immunomodulation, and thromboprophylaxis can result in significantly better outcome
Summary
Findings of our series suggest that COVID-19 can trigger hyperinflammatory state resulting in shock and pulmonary involvement, in some of the patients. The patients presented with distinct clinical features, with some mimicking atypical KD, the underlying mechanism for which still remain unclear. The physicians should be suspicious of MIS-C in adolescents presenting with fever, rash, and gastrointestinal symptoms. Personalized treatment including hemodynamic and respiratory support together with empirical antibiotics, fluids, inotropes, thromboprophylaxis, and immunomodulatory therapy was provided. Notwithstanding the requirement of MICU admission, the overall prognosis was good. Abbreviations 2D ECHO: Two-dimensional echocardiography; COVID-19: Coronavirus disease 2019; HRCT: High-resolution computed tomography; IgG: Immunoglobulin G; KD: Kawasaki disease; MICU: Medicine intensive care unit; MIS: Multisystem inflammatory syndrome; MIS-C: Multisystem inflammatory syndrome in children; RT-PCR: Real-time polymerase chain reaction; SARS-CoV-2: Severe acute respiratory syndrome coronavirus-2; SCD: Sickle cell disease; TSS: Toxic shock syndrome
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