Paediatric post-COVID-19 hyperinflammatory syndrome mimicking appendicitis: a case series

Area of Science:

• Pediatric Infectious Diseases
• Pediatric Critical Care Medicine
• Pediatric Surgery

Background:

• A novel hyperinflammatory syndrome, Pediatric Inflammatory Multisystem Syndrome - Temporally associated with SARS-CoV-2 (PIMS-TS), has emerged in children.
• PIMS-TS can present with acute abdominal pain, mimicking surgical emergencies like appendicitis.
• A significant proportion of PIMS-TS patients develop shock and cardiac dysfunction.

Purpose of the Study:

• To describe the clinical presentation of PIMS-TS in pediatric patients presenting with acute abdominal pain.
• To differentiate PIMS-TS from appendicitis in the pediatric population.
• To highlight the importance of considering PIMS-TS in the differential diagnosis of acute abdomen in children.

Main Methods:

• Prospective case series of PIMS-TS patients presenting to a UK tertiary pediatric center.
• Analysis of clinical presentation, laboratory findings, imaging results, and surgical outcomes.
• Comparison of PIMS-TS cohort with children undergoing appendectomy for confirmed appendicitis.

Main Results:

• 19 out of 89 PIMS-TS patients (21.3%) were referred for surgical review due to abdominal pain.
• Pyrexia and abdominal pain were universal; elevated C-reactive protein (CRP) and ferritin were significantly higher in PIMS-TS compared to appendicitis.
• Two patients underwent appendectomy for presumed appendicitis but were later diagnosed with PIMS-TS; 8 had abnormal echocardiograms.

Conclusions:

• PIMS-TS frequently mimics appendicitis in children, presenting with acute abdominal pain.
• Consideration of PIMS-TS is crucial to avoid unnecessary appendectomies in children.
• Early diagnosis of PIMS-TS can prevent potential cardiovascular complications associated with delayed management.