Post-COVID-19 patient with overlapping features between Multisystem inflammatory syndrome in children (MIS-C) and Secondary hemophagocytic lymphohistiocytosis (SHLH): A Rare Case Report

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a potentially life-threatening consequence of coronavirus disease (COVID-19) infection characterized by hyperinflammatory state, leading to multi-organ damage that often requires hospitalization. Though the precise underlying etiopathogenesis of MIS-C is not completely comprehended, the correlation between MIS-C and COVID-19 infection implies a delayed immune response dysregulation in the post-COVID-19 infection setting. MIS-C patients may have a wide spectrum of manifestations including fever, elevated inflammatory parameters and signs of end organ damage including myocarditis, cardiac disfunction, gastrointestinal manifestations, respiratory impairment, acute kidney injury, and/or hematologic, dermatologic and/or neurological involvement. Although MIS-C may overlap with other well understood hyperinflammatory conditions such as secondary hemophagocytic lymphohistiocytosis (SHLH) in several Clinical features and laboratory findings, striking manifestations including Gastrointestinal and cardiac ones make the direction of the diagnostic compass geared more towards MIS-C which are unusual components of disease process in SHLH. Besides that, MIS-C can be distinguished from SHLH in the amplitude and severity of hyperinflammation, which are more pronounced in SHLH. Because of the overlap, diagnosis of MIS-C requires a high clinical index as prompt recognition and early intervention have favorable prognostic outcomes. We herein report a 5-year-old male child patient who presented with overlapping features between MIS-C and SHLH in a post-COVID-19 setting.