Does Multisystem Inflammatory Syndrome Only Mimic Acute Appendicitis in Children or Can It Coexist: When Should We...

Area of Science:

• Pediatric Surgery
• Pediatric Infectious Diseases
• Pediatric Gastroenterology

Background:

• Acute abdominal pain is a common presentation for multisystem inflammatory syndrome in children (MIS-C).
• MIS-C can occur independently or concurrently with acute appendicitis.
• Differentiating MIS-C from acute appendicitis is crucial for appropriate management.

Purpose of the Study:

• To distinguish between typical acute appendicitis and MIS-C in pediatric patients.
• To identify key clinical and laboratory criteria for diagnosing MIS-C presenting with abdominal pain.

Main Methods:

• Retrospective analysis of 76 pediatric patients admitted over six months in 2021.
• Cases were categorized into four groups: acute appendicitis, MIS-C with appendicitis, MIS-C only, and appendicitis with COVID-19.
• Comparison of clinical and laboratory findings including symptom duration, C-reactive protein (CRP) levels, fever, and other system involvement.

Main Results:

• Significant differences observed in symptom duration (p < 0.0001), CRP levels (p < 0.0001), fever presence (p < 0.0001), and other system involvement (p < 0.0001) across groups.
• A combination of criteria (CRP > 55.8 mg/L, symptoms ≥ 3 days, fever, other system involvement) demonstrated high predictive value for MIS-C (AUC = 0.983, sensitivity 94.3%, specificity 92.7%).

Conclusions:

• MIS-C should be suspected in pediatric patients presenting with symptoms suggestive of acute appendicitis, especially when specific criteria are met.
• The presence of at least three of the four key signs (elevated CRP, prolonged symptoms, fever, other system involvement) strongly suggests MIS-C.
• Recent COVID-19 contact or infection history further supports suspicion of MIS-C.