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Challenges in diagnosing COVID-19 related disease in pediatric patients with rheumatic disease
Seher Sener1, Ozge Basaran1, Sibel Lacinel Gurlevik2
1Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Ankara, Turkey.
Insights
Multisystem inflammatory syndrome in children (MIS-C) can mimic symptoms of rheumatic diseases like familial Mediterranean fever and juvenile idiopathic arthritis. Early recognition is key, as overlapping signs may delay MIS-C diagnosis in these patients.
Area of Science:
- Pediatric Rheumatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a severe condition linked to COVID-19.
- Patients with pre-existing rheumatic diseases may present unique diagnostic challenges for MIS-C.
Purpose of the Study:
- To highlight the overlapping clinical and laboratory features of MIS-C in children with rheumatic conditions.
- To emphasize the diagnostic difficulties and potential delays in identifying MIS-C in this patient cohort.
Main Methods:
- Retrospective analysis of six pediatric patients with MIS-C and prior rheumatic disease.
- Evaluation of demographic data, clinical presentations, laboratory results, imaging, treatments, and outcomes.
Main Results:
- Patients had conditions including familial Mediterranean fever (FMF), juvenile dermatomyositis, and juvenile idiopathic arthritis (JIA).
- Common symptoms included fever, abdominal pain, and elevated inflammatory markers; some showed pneumonia or cardiac dysfunction.
- All patients received immunotherapy (IVIG, methylprednisolone), with four also receiving anakinra.
Conclusions:
- MIS-C symptoms can significantly overlap with various rheumatic diseases.
- This overlap poses a diagnostic challenge, potentially leading to delayed MIS-C diagnosis in affected children.
Objectives:
Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe condition associated with coronavirus disease 2019. Here we aimed to raise awareness for the symptoms of MIS-C in patients with rheumatic diseases, emphasizing the challenges of the differential features.
Methods:
We retrospectively evaluated the demographic and clinical characteristics, laboratory and imaging findings, treatments, and outcomes of six MIS-C patients with previous rheumatic disease.
Results:
Three of the patients had familial Mediterranean fever (FMF), one had juvenile dermatomyositis, one had systemic juvenile idiopathic arthritis (JIA), and another patient had oligoarticular JIA. All FMF patients presented with fever and abdominal pain, two also had chest pain. The patient with systemic JIA presented with fever, rash, and myalgia. All patients had elevated inflammatory markers and high d-dimer levels. Chest imaging of two FMF patients showed infiltrations compatible with pneumonia. One FMF patient had mildly decreased systolic functions with a shortening fraction of 48% in his echocardiography. Intravenous immunoglobulin and methylprednisolone were administered to all patients. Anakinra was given to four patients.
Conclusions:
Clinical and laboratory signs of MIS-C may overlap with the findings of various rheumatic diseases, and this may cause a delay in diagnosis.
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