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Published on: January 16, 2019
Multisystem inflammatory syndrome in children (MIS-C) presenting with valvulitis, myocarditis, and QTc prolongation:
Sultan Alharthi1, Suzan Abdullah Jafri2, Mazen A Alzaedi1
1Pediatric Department, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia.
Insights
Multisystem inflammatory syndrome in children (MIS-C) can mimic appendicitis. Early diagnosis and multidisciplinary care are crucial for preventing severe cardiac complications in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a significant post-Coronavirus disease 2019 sequela.
- MIS-C presents complex clinical challenges, often mimicking other pediatric conditions.
- Maintaining a high index of suspicion for MIS-C is vital in pediatric differential diagnoses.
Purpose of the Study:
- To report a case of MIS-C with initial presentation mimicking acute appendicitis.
- To highlight the successful multidisciplinary management of a pediatric patient with MIS-C.
- To emphasize the importance of early recognition and intervention for MIS-C to prevent cardiac complications.
Main Methods:
- A case report of an 11-year-old girl with initial gastrointestinal symptoms and subsequent cardiovascular compromise.
- Diagnosis of MIS-C was confirmed based on CDC and WHO criteria, including cardiac involvement (prolonged QT, reduced ejection fraction).
- Management involved a multidisciplinary team utilizing intravenous immunoglobulin, corticosteroids, inotropes, diuretics, aspirin, and antibiotics.
Main Results:
- The patient presented with symptoms initially suggestive of appendicitis, progressing to cardiovascular compromise.
- Cardiac workup revealed significant abnormalities, leading to a MIS-C diagnosis.
- The patient achieved full cardiac recovery over a one-year follow-up period.
Conclusions:
- Pediatric patients presenting with abdominal pain may have MIS-C, necessitating a broad differential diagnosis.
- Prompt diagnosis and integrated multidisciplinary care are critical for optimal outcomes in MIS-C.
- Early intervention significantly reduces the risk of severe cardiac complications associated with MIS-C.
Rationale:
This case report highlights the complex clinical course and successful multidisciplinary management of a pediatric patient with multisystem inflammatory syndrome in children (MIS-C), who posed clinical dilemma at presentation. It underscores the ongoing clinical relevance of MIS-C as a post-Coronavirus disease 2019 sequelae and emphasizes the importance of maintaining a high index of suspicion for MIS-C in pediatric differential diagnoses, especially when symptoms overlap with other common conditions.
Patient Concerns:
An 11-year-old previously healthy Saudi girl presented with gastrointestinal symptoms initially suggestive of acute appendicitis. Her condition rapidly deteriorated with signs of cardiovascular compromise.
Diagnoses:
Surgical exploration confirmed a perforated appendix. Cardiac workup revealed elevated troponin levels, corrected QT interval prolongation (500 ms), ST-segment changes, and echocardiographic evidence of mitral and aortic regurgitation with reduced ejection fraction, leading to a diagnosis of MIS-C fulfilling both Centers for Disease Control and Prevention and World Health Organization criteria. Schwartz et al's criteria are widely accepted for diagnosing long QT syndrome, which guided our interpretation of the corrected QT interval prolongation observed in this case. According to the Centers for Disease Control and Prevention, MIS-C is defined by a constellation of symptoms occurring in individuals under 21 years with recent severe acute respiratory syndrome coronavirus 2 infection or exposure.
Interventions:
Management included intravenous immunoglobulin, corticosteroids, inotropes, diuretics, aspirin, and broad-spectrum antibiotics, coordinated by a multidisciplinary care team.
Outcomes:
The patient experienced full cardiac recovery, confirmed through serial electrocardiogram and echocardiography over 1 year.
Lessons:
This case underscores the importance of recognizing MIS-C in children presenting with atypical symptoms such as abdominal pain. Timely diagnosis and early multidisciplinary intervention are essential to prevent serious cardiac complications.
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