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Scrotal pain as a novel symptom of multisystem inflammatory syndrome in children (MIS-C): Report from Riyadh, Saudi
Lama AlFakhri1, Abdullah F AlSaeed2, Majed B AlZin3
1Dr. Lama AlFakhri, MD Department of Emergency Medicine, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
Insights
A previously healthy child experienced severe scrotal pain and swelling, a rare symptom of pediatric Multi-System Inflammatory Syndrome (MIS-C) following COVID-19. Prompt diagnosis and management led to a full recovery.
Area of Science:
- Pediatric infectious diseases
- Pediatric critical care medicine
- Pediatric rheumatology
Background:
- Multi-System Inflammatory Syndrome in children (MIS-C) is a serious condition linked to SARS-CoV-2 infection.
- While MIS-C commonly presents with fever, rash, and gastrointestinal symptoms, atypical presentations require further investigation.
Observation:
- A previously healthy child presented with acute abdominal and scrotal pain, fever, vomiting, and diarrhea.
- Initial investigations ruled out testicular torsion and appendicitis; CT scan indicated terminal ileitis.
- The patient had a recent history of COVID-19, with MIS-C panel showing elevated inflammatory markers and positive SARS-CoV-2 IgG.
Findings:
- The child was diagnosed with MIS-C, exhibiting scrotal pain and swelling as an unusual primary symptom.
- Cardiac enzymes were elevated, but echocardiogram revealed only minor valvular regurgitation.
- The patient recovered fully with appropriate management.
Implications:
- This case highlights the diverse and sometimes unexpected clinical manifestations of MIS-C in children.
- Recognizing scrotal symptoms as a potential MIS-C presentation is crucial for timely diagnosis and treatment.
- Further research into MIS-C's varied presentations and treatment efficacy is needed for improved patient outcomes.
Abstract:
A previously healthy child, presented with severe abdominal and scrotal pain with scrotal swelling for five days. There was associated fever, vomiting, and diarrhea. There was history of COVID-19 infection in the previous month. The patient was febrile (39°C), and in pain. His other vitals were unremarkable. Testicular torsion and appendicitis were ruled out by ultrasound. Abdominal CT scan showed signs indicating terminal ileitis. His MIS-C panel revealed elevated inflammatory markers and cardiac enzymes and positive SARS-CoV-2 IgG levels. All cultures and RT-PCR COVID-19 were negative. Echocardiogram showed only minor mitral and tricuspid regurgitation. The patient was diagnosed as a case of MIS-C. and recovered completely on management. Our patient showed an inexplicable previously unreported complaint of scrotal pain and swelling as a symptom of MIS-c. Further research tackling MIS-C's different presentations and comparing the efficacy of the different treatment methods will help us better manage this disease.
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