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Misdiagnosis of multisystem inflammatory syndrome in children: A diagnostic challenge
Gulhadiye Avcu1, Asli Arslan1, Sema Y Arslan1
1Faculty of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Ege University, Izmir, Turkey.
Insights
Multisystem inflammatory syndrome in children (MIS-C) can be mistaken for common febrile illnesses. Prompt diagnosis and treatment are crucial for preventing severe outcomes in children with MIS-C.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Multisystem inflammatory syndrome in children (MIS-C) remains a critical diagnosis during the COVID-19 pandemic.
- Prompt diagnosis and treatment of MIS-C are essential to prevent severe clinical sequelae.
Purpose of the Study:
- To evaluate the clinical presentation, diagnostic parameters, and management of MIS-C.
- To compare the clinical features of MIS-C with common febrile diseases.
Main Methods:
- Retrospective comparison of clinical and laboratory findings.
- Study included 106 children initially suspected of MIS-C at a tertiary university hospital (December 2020 - October 2022).
- Compared 68 confirmed MIS-C cases with 38 children with alternative diagnoses.
Main Results:
- Infectious causes (71%) were most commonly misdiagnosed as MIS-C.
- MIS-C patients were older, with more severe illness (respiratory distress, shock, PICU admission).
- Distinctive features for MIS-C included conjunctivitis, higher CRP, lower platelets, and echocardiographic abnormalities; older age, conjunctivitis, high CRP, and low platelets predicted MIS-C.
Conclusions:
- No specific diagnostic markers currently exist for MIS-C, leading to potential confusion with other conditions.
- Further research is needed to aid clinicians in differentiating MIS-C.
- Diagnostic criteria for MIS-C require ongoing updates.
Aims:
As the COVID-19 pandemic continues, multisystem inflammatory syndrome in children (MIS-C) maintains its importance in the differential diagnosis of common febrile diseases. MIS-C should be promptly diagnosed because corticosteroid and/or intravenous immunoglobulin treatment can prevent severe clinical outcomes. In this study, we aimed to evaluate clinical presentation, diagnostic parameters and management of MIS-C and compare its clinical features to those of common febrile disease.
Methods:
This study was conducted at a tertiary-level university hospital between December 2020 and October 2022. One hundred and six children who were initially considered to have MIS-C disease were included in the study. During the follow-up period in the hospital, when the clinical and laboratory findings were re-evaluated, 38 out of 106 children were diagnosed differently. The clinical and laboratory findings of 68 children followed up with the diagnosis of MIS-C and 38 children who were initially misdiagnosed as MIS-C but with different final diagnoses were retrospectively compared.
Results:
We identified 68 patients with MIS-C and 38 patients misdiagnosed as MIS-C during the study period. Infectious causes (71%), predominantly bacterial origin, were the most frequently confused conditions with MIS-C. Patients with MIS-C were older and had a more severe clinical course with high rates of respiratory distress, shock, and paediatric intensive care unit admission. While rash and conjunctivitis were more common among patients with MIS-C, cough, abdominal pain and diarrhoea were observed more frequently in patients misdiagnosed as MIS-C. Lower absolute lymphocyte counts, platelet counts and higher C-reactive protein and fibrinogen levels, pathological findings on echocardiography were the distinctive laboratory parameters for MIS-C. Multivariate analysis showed that older age, presence of conjunctivitis, high level of serum CRP and lower platelets were the most discriminative predictors for the diagnosis of MIS-C.
Conclusion:
There are still no specific findings to diagnose MIS-C, which therefore can be confused with different clinical conditions. Further data are needed to assist the clinician in the differential diagnosis of MIS-C and the diagnostic criteria should be updated over time.
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