Dengue Versus Multisystem Inflammatory Syndrome - When the Grey Zone Gets Thinner

Area of Science:

• Infectious Diseases
• Pediatrics
• Internal Medicine

Background:

• Multisystem inflammatory syndrome (MIS) is a hyperinflammatory condition following SARS-CoV-2 infection.
• While initially observed in children, MIS is increasingly diagnosed in adults (MIS-A).
• Overlapping clinical and laboratory features of MIS-A and dengue pose diagnostic challenges in endemic regions.

Observation:

• A young male presented with fever, gastrointestinal issues, rash, and thrombocytopenia, testing positive for dengue NS1 antigen.
• Atypical features included early thrombocytopenia, severe gastrointestinal symptoms, and prolonged fever, raising suspicion for MIS in adults (MIS-A).
• Absence of neurological/cardiac symptoms, stable hemodynamics, no mucosal involvement, and negative inflammatory markers supported a dengue diagnosis.

Findings:

• The case highlights the diagnostic dilemma between MIS-A and dengue in endemic areas.
• Clinical presentation can be ambiguous, necessitating a high index of suspicion for MIS-A.
• Careful assessment of atypical symptoms and exclusion of specific MIS criteria are crucial.

Implications:

• Clinicians must be vigilant in differentiating MIS-A from dengue, particularly in co-endemic regions.
• Further research is needed to establish clear diagnostic criteria for MIS-A in adults.
• Accurate diagnosis is essential for appropriate patient management and public health strategies.