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Case Series of Clinical Findings of Multi-System Inflammatory Syndrome in Children in Contrast to Kawasaki Disease
Htay H Aung1, Oksana Nulman1, Iram Nadroo1
1Pediatric Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA.
Insights
Multi-system inflammatory syndrome in children (MIS-C) linked to SARS-CoV-2 is a growing concern. Early recognition and cardiac evaluation are crucial for prompt treatment of this Kawasaki-like condition in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- The COVID-19 pandemic has seen a rise in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-linked Kawasaki-like disease in children.
- This evolving syndrome, termed multi-system inflammatory syndrome in children (MIS-C), presents with atypical Kawasaki features and potential shock.
Observation:
- Three pediatric cases of MIS-C associated with SARS-CoV-2 are reported.
- Patients presented with persistent fever, mucocutaneous, and gastrointestinal symptoms.
- All patients tested positive for COVID-19 antibodies.
Findings:
- MIS-C is a distinct entity from Kawasaki disease, characterized by high inflammatory markers.
- Cardiac evaluation is essential for diagnosing and managing MIS-C.
- Prompt diagnosis and intervention are critical due to potential for shock.
Implications:
- Increased clinical suspicion and a low threshold for diagnostic workup are necessary for timely MIS-C treatment.
- Understanding MIS-C's unique presentation and diagnostic criteria is vital for pediatric emergency care.
- This condition highlights the diverse systemic manifestations of SARS-CoV-2 infection in children.
Abstract:
Several months into the coronavirus disease 2019 (COVID-19) pandemic, there is growing concern over an increase in the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-linked Kawasaki-like disease in the pediatric population. The pediatric patients presented to the emergency room with impending shock in the setting of an atypical Kawasaki picture. On May 14, 2020, the CDC Health Alert Network released a case definition for this evolving syndrome and named it multi-system inflammatory syndrome in children (MIS-C). We report three cases of MIS-C associated with SAR-COV2 who presented to our emergency room. Persistent fever was present in all three patients and mucocutaneous and gastrointestinal symptoms were the most common associations. All three patients were found to have antibodies to COVID-19. MIS-C is a similar but distinct entity as compared to Kawasaki disease. High inflammatory markers are supportive of the diagnosis, and cardiac evaluation is crucial in MIS-C. High suspicion for the diagnosis and low threshold for workup will prevent delayed treatment.
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