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Five days of fever and myocardial inflammation
Keli D Coleman1, Paul Benz2, Nirzar S Parikh3
1Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
Insights
Early identification of multisystem inflammatory syndrome in children (MIS-C) is crucial. This case suggests that testing after 4 days of fever, rather than 24 hours, may provide more reliable MIS-C diagnosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious condition linked to SARS-CoV-2.
- Current diagnostic guidelines for MIS-C lack robust evidence, particularly regarding optimal timing for laboratory testing.
- Early recognition is vital for timely intervention and improved patient outcomes.
Observation:
- This report details a pediatric patient with MIS-C, offering near-daily symptom and laboratory data.
- Key laboratory abnormalities like thrombocytopenia, anemia, and myocardial inflammation appeared on the fifth day of fever.
- Clinical signs including rash, conjunctivitis, vomiting, and diarrhea correlated with the onset of these laboratory findings.
Findings:
- The patient's presentation indicates that MIS-C may manifest with delayed laboratory abnormalities.
- Symptoms such as rash, conjunctivitis, vomiting, and diarrhea can serve as important indicators for initiating blood tests.
- The observed timeline challenges the CDC's recommendation for MIS-C testing within 24 hours of fever onset.
Implications:
- Testing for MIS-C within 24 hours of fever may lead to false-negative results.
- A diagnostic approach considering at least 4 days of fever may improve the reliability of MIS-C detection.
- This case highlights the need for revised diagnostic criteria and timing recommendations for MIS-C.
Abstract:
Multisystem inflammatory syndrome in children is an emerging pediatric illness associated with severe acute respiratory syndrome coronavirus 2 infection. The syndrome is rare, and evidence-based guidelines are lacking. This report reviews a patient who presented for medical care multiple times early in the course of his illness, thus offering near-daily documentation of symptoms and laboratory abnormalities. The patient did not have thrombocytopenia, anemia, or myocardial inflammation until the fifth day of fever. These laboratory abnormalities coincided with the onset of rash, conjunctival injection, vomiting, and diarrhea: clinical signs that could serve as indicators for when to obtain blood tests. The timing of this patient's onset of multisystem involvement suggests that testing for multisystem inflammatory syndrome in children after only 24 h of fever, as the Centers for Disease Control and Prevention recommends, may yield false-negative results. Testing for multisystem inflammatory syndrome in children after 4 days of fever may be more reliable.
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