Child with post COVID MISC presenting with atypical Kawasaki like features in a rural medical college
Abstract
COVID-19 in pediatric population is often milder but a segment of cases tend to worsen out and present with pediatric multi system inflammatory syndrome. Here we present a 3 year-old female child presenting with acute febrile illness, generalized rashes with loose stools. On examination child was in fluid refractory shock requiring vasoactives, oxygen by non-rebreather mask, antibiotics and other supportive. Investigations revealed neutrophilic leukocytosis, with normal absolute lymphocyte count, thrombocytopenia and elevated inflammatory markers with negative COVID real time-polymerase chain reaction (RT PCR) and positive COVID immunoglobulin G (IgG) antibody, suggesting a post COVID-19 sequelae. Children presenting with multisystem inflammatory syndrome in children (MIS-C) most often have a silent course of acute COVID infection. Lymphopenia and thrombocytosis are not always associated with MIS-C. COVID antibody with inflammatory markers like C-reactive protein (CRP), D-dimer plays an important role in the management and during follow up. More pediatric studies are needed regarding the role of aspirin in MIS-C with Kawasaki disease overlap, choice of anticoagulant in a thrombocytopenic child and any markers which could predict the development of MIS-C during acute COVID infection.
Keywords
Full Text:
PDFReferences
Nakra NA, Blumberg DA, 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.
WHO Coronavirus Disease (COVID-19) Dashboard. Available at: https://covid19.who.int/. Accessed on: 20 September 2020.
Fadel R, Morrison AR, Vahia A, Smith ZR, Chaudhry Z, Bhargava P, et al. COVID-19 Management Task Force. Early Short-Course Corticosteroids in Hospitalized Patients with COVID-19. Clin Infect Dis. 2020;71(16):2114-20.
Wang Y, Jiang W, He Q, Wang C, Liu B, Dong N, et al. Early, low-dose and short-term application of corticosteroid treatment in patients with severe COVID-19 pneumonia: single-centre experience from Wuhan, China. Medrxiv. 2020.
Hennon TR, Penque MD, Abdul-Aziz R, Alibrahim OS, McGreevy MB, Prout AJ, et al. COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; a Western New York approach. Prog Pediatr Cardiol. 2020:101232.
Kest H, Kaushik A, DeBruin W, Colletti M, Goldberg D. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with 2019 Novel Coronavirus (SARS-CoV-2) Infection. Case Rep Pediatr. 2020;8875987.
Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA. 2020;324(3):259-69.
Rowley AH, Shulman ST, Arditi M. Immune pathogenesis of COVID-19-related multisystem inflammatory syndrome in children. J Clin Invest. 2020;130(11):5619-21.
Okarska-NapieraĆa M, Zalewska E, Kuchar E. Fever and diarrhea as the only symptoms of Multisystem Inflammatory Syndrome in Children (MIS-C). Gastroenterology. 2020;S0016-5085(20):35118-20.
Nguyen DC, Haydar H, Pace ER. Pediatric Case of Severe COVID-19 with Shock and Multisystem Inflammation. Cureus. 2020;12(6):e8915.