A rare presentation of COVID-19 in a ten-year-old girl
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v31.i3.22180Keywords:
case report, COVID-19, Kawasaky Disease, multisystem inflammatory syndrome in children, SARS-CoV-2Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a severe and rare manifestation of SARS-CoV-2 infection.
A 10-year-old-girl without epidemiological context of COVID-19 presented with fever, headache, and vomiting with two days of evolution. She was hemodynamically stable. Laboratory tests showed lymphopenia, mild thrombocytopenia, and positive C-reactive protein. Reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 was negative. On the third day, she presented with worsening symptoms and non-pruriginous, non-petechial rash, with also worsening inflammatory parameters on laboratory assessment. The girl was admitted, and RT-PCR for SARS-CoV-2 was repeated, with positive result. On the fourth day, the patient was hypotensive, lethargic, and showed delayed capillary refill time, swelling and erythema of the palpebrae and nose, bilateral non-purulent conjunctivitis, reddened and cracked lips, strawberry tongue, and inflammation of mucous membranes. Multiorgan dysfunction developed, and she required admission to the Intensive Care Unit.
MIS-C is a severe and potentially fatal syndro me, which clinicians should be aware of in the present pandemic setting. Close cardiac follow-up is recommended.
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References
Nakra N, Blumberg D, Herrera-Guerra A, Lakshminrusimha S. Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed Management.
Children (Basel). 2020;7(7):69.
Rowley, A. Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children. Nat Rev Immunol. 2020;20(8):453-4.
Feldstein L, Rose E, Horwitz S, Collins J, Newhams M, Son M, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020;383(4):334-46.
Kaushik A, Gupta S, Sood M, Sharma S, Verma S. A Systematic Review of Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection. Pediatr Infect Dis J. 2020;39(11):e340-e346.
Sperotto F, Friedman K, Son M, VanderPluym C, Newburger J, Dionne A. Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. Eur J Pediatr. 2020;15:1–16.
Jiang L, Tang K, Levin M, Irfan O, Morris S, Wilson K, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis. 2020;20(11):e276-e288.
Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020; 395: 1771–78.
Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J, et al. Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation, Pediatric Respiratory Reviews, https://doi.org/10.1016/j.prrv.2020.08.001.
Toubiana, J, Poirault C, Corsia A, Bajolle F, Fourgeaud J, Angoulvant F, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ. 2020;369:m2094.
Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K, et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine. 2020;26:100527.
He X, Lau E, Wu P, Deng X, Wang J, Hao X , et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med 2020; 26:672.
Liu WD, Chang SY, Wang JT, Tsai MJ, Hung CC, Hsu CL, et al. Prolonged virus shedding even after seroconversion in a patient with COVID-19. J Infect. 2020 Aug;81(2):318-356. http/doi.org/10.1016/j.jinf.2020.03.063. Epub 2020 Apr 10.
Center for Disease Control and Prevention, Center for Preparedness and Response: Information for Healthcare Providers about Multisystem Inflammatory Syndrome in Children (MIS-C) Available at: https://www.cdc.gov/mis-c/hcp/ (Accessed on December 08, 2020).
Ouldali N, Toubiana J, Antona D, Javouhey E, Madhi F, Lorrot M, et al. Association of Intravenous Immunoglobulins Plus Methylprednisolone vs Immunoglobulins Alone With Course of Fever in Multisystem Inflammatory Syndrome in Children. JAMA 2021; http/doi.org/10.1001/jama.2021.0694.
Meena P, Pallavi, Mishra D, Jhamb U, Aggarwal M. Low-Dose Dexamethasone Following IVIG in Pediatric Inflammatory Multisystem Syndrome in Temporal Association with COVID-19 (PIMS-TC). Indian J Pediatr. 2021;88(3):301-2. http/doi.org/10.1007/s12098-020-03509-3. Epub 2020 Oct 6.
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