WE8.6 Paediatric inflammatory multisystem syndrome presenting as acute appendicitis: a case report and literature review

Abstract

AimsPaediatric inflammatory multisystem syndrome– temporally associated with SARS-CoV-2 (PIMS-TS) is a novel hyperinflammatory condition that most commonly presents with an acute abdomen. Here we present a case of PIMS-TS mimicking appendicitis and a review of the literature with a proposed protocol for managing abdominal pain in patients with recent SARS-CoV-2 infection.ResultsAn 8-year old girl presented with suspected appendicitis. She underwent a day case open appendicectomy with normal appendix confirmed on histology. Unfortunately, she re-presented the following day with persistently high fever and was investigated for post-appendicectomy complication. She was started on intravenous antibiotics. MRI of abdomen and pelvis showed no collection but evidence of lymphadenopathy. On post-operative day four she was transferred to the tertiary centre PICU for specialist management of suspected severe PIMS-TS.Common abdominal radiological findings in PIMS-TS include ascites, bowel wall thickening and mesenteric inflammation. In addition, CRP and ferritin have been found to be significantly higher in PIMS-TS. White cells may be raised with neutrophilia and lymphopaenia. In addition, highly deranged inflammatory markers in the context of a normal abdominal imaging are more consistent with PIMS-TS than appendicitis. We propose anyone with these findings is considered as having PIMS-TS and requires urgent imaging including combined senior surgical and paediatrician review.ConclusionPIMS-TS may present mimicking acute appendicitis and given the severe cardiac compromise that can develop in patients with PIMS-TS is it important to avoid unnecessary general anaesthetic and abdominal surgery where possible. Our proposed protocol could help reduce unnecessary abdominal surgery in these patients.