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Expanding the Differential for Alternative Diagnoses in the Workup of Multisystem Inflammatory Syndrome in Children
Kelli Kaneta1, Sanchi Malhotra2,3, Jacqueline Szmuszkovicz4
1From the Department of Pediatrics.
Insights
Many children evaluated for Multisystem Inflammatory Syndrome in Children (MIS-C) have other conditions. Infectious causes were the most frequent MIS-C mimickers, aiding in diagnosis.
Area of Science:
- Pediatric infectious diseases
- Pediatric rheumatology
- Pediatric critical care
Background:
- Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare condition linked to SARS-CoV-2.
- Increasing numbers of children are evaluated for MIS-C, but many receive alternative diagnoses.
Purpose of the Study:
- To identify and characterize conditions that mimic MIS-C in pediatric patients.
- To differentiate MIS-C from other diagnoses presenting with similar symptoms.
Main Methods:
- Retrospective review of pediatric patients (<21 years) hospitalized with suspected MIS-C.
- Analysis of data from August 2020 to July 2021 using an institutional MIS-C order entry set.
- Medical record review for final diagnoses and categorization of MIS-C mimickers.
Main Results:
- Out of 359 patients, 126 (35.1%) met MIS-C criteria.
- 194 (54.0%) were classified as MIS-C mimickers, with infectious diagnoses being the most common (78.9%).
- Bacterial and viral etiologies were observed with similar frequency among infectious mimickers.
Conclusions:
- MIS-C mimickers span various subspecialties, predominantly featuring infectious causes.
- Identifying these mimickers can guide clinicians toward appropriate diagnostic testing.
- This approach aims to facilitate timely and accurate diagnoses for pediatric patients.
Background:
Multisystem inflammatory syndrome in children (MIS-C) is a rare inflammatory syndrome associated with SARS-CoV-2 infection. Children are increasingly admitted for MIS-C evaluation, but instead found to have alternative diagnoses.
Methods:
Retrospective study of all pediatric patients <21 years of age hospitalized between August 1, 2020, and July 31, 2021, with clinical concern for MIS-C at the time of presentation were identified through use of an institutional computerized MIS-C order entry set. Final diagnoses were then collected through primary review of the medical record from the time of initial presentation through 1-month postdischarge.
Results:
Of 359 cases identified through the MIS-C order entry set, 126 (35.1%) met criteria for MIS-C, 28 had Kawasaki Disease (KD) (7.8%), and 11 cases met criteria for both MIS-C and KD (3.1%), leaving 194 (54.0%) patients ruled out and categorized as "MIS-C mimickers." Infectious diagnoses were the most common MIS-C mimickers (78.9%). Of the infectious etiologies, bacterial (51.0%) and viral (52.3%) etiologies were seen with similar frequency.
Conclusions:
We describe MIS-C mimickers spanning multiple subspecialties, with infectious etiologies predominating, which can aid clinicians in the consideration of diagnostic testing, with the goal of achieving timely and accurate diagnoses.
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