Multisystem Inflammatory Syndrome in Children: A Mimicker of Severe Dengue

Multisystem inflammatory syndrome following COVID-19 infection mimicking abdominal tuberculosis in Nepal: A case report

Introduction and importance

Multisystem Inflammatory Syndrome in Children (MIS-C) is an uncommon condition that can present with a wide range of clinical features and complications. As it can be confused with various diseases, diagnosis is crucial as proper management can improve the patient's condition.

Case presentation

14-year male presented with fever, abdominal pain, and cough on September 2021. On examination, he was febrile with a distended abdomen and enlarged liver. Following investigations, abdominal tuberculosis was suspected but his condition improved with broad-spectrum antibiotics, intravenous immunoglobulins, and high-dose steroids.

Clinical discussion

Any children with COVID 19 infection who have fever with multiple systems involved after ruling out other causes of infections should be suspected to have MIS-C. Diagnosis can be challenging as its clinical presentation mimics conditions like Kawasaki disease, ricketssial disease and acute appendicitis, etc. In high prevalence countries, with predominant gastrointestinal features, it can be confused with abdominal tuberculosis as well, hence, proper diagnosis is crucial.

Conclusion

The course of MIS-C can be fatal where most children require intensive care units and early institution of immunomodulatory therapy for their recovery. Also, all pediatricians need to have a high degree of suspicion to diagnose MIS-C as it can be confused with different illnesses.

Overlapping Clinical Manifestations of Multisystem Inflammatory Syndrome in Children with Other Endemic Diseases of Pakistan: A Case Report

Multisystem inflammatory syndrome (MIS-C) is a challenging disease associated with COVID-19. Clinical manifestation of MIS-C may mimic many endemic illnesses of tropical and subtropical countries, making early diagnosis more difficult. The authors present the case of an 8-year-old who presented with non-specific febrile illness which was managed as extensively drug-resistant typhoid with meropenem. The patient developed abdominal pain and hypotension during the hospital stay. Surgical causes were ruled out and managed with fluid protocol of dengue shock syndrome on the basis of falling platelets and fluid leak on ultrasound. But refractory condition and new-onset cardiac dysfunction prompted alternate diagnosis. Diagnostic criteria of MIS-C were fulfilled and the patient was managed with a single dose of intravenous Ig, pulse therapy of methylprednisolone, and temporary pacemaker placement. MIS-C should be kept in the differentials of diseases with multisystem involvement in the wake of the COVID-19 pandemic, as its clinical spectrum closely mimics other endemic illnesses of tropical and subtropical regions.

Pediatric Scrub Typhus Manifesting with Multisystem Inflammatory Syndrome: A New Cause for Confusion or Concern—A Case Series

The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has discovered a new disease called multisystem inflammatory syndrome in children (MIS-C). In developing nations, pediatricians must be mindful of the similarities between MIS-C and other tropical fevers such as scrub typhus. Not only should such patients be kept on high alert to rule out tropical diseases and receive appropriate treatment, such as steroids or immunomodulatory medications, but this is also concerning because, if rickettsial or bacterial infection is not detected through cultures and serology, steroid, or immunomodulatory treatment alone can be fatal.

How to cite this article: Bhardwaj P, Sood M, Singh R. Pediatric Scrub Typhus Manifesting with Multisystem Inflammatory Syndrome: A New Cause for Confusion or Concern—A Case Series. Indian J Crit Care Med 2022;26(6):723–727.

Comparison of Multisystem Inflammatory Syndrome (MIS-C) and Dengue in Hospitalized Children

OBJECTIVE

Multisystem inflammatory syndrome (MIS-C) in children is a febrile illness that has overlapping presentation with other locally prevalent illnesses. Clinicolaboratory profile of children admitted with MIS-C and dengue were compared to understand their presentation at the outset.

METHODS

This was a retrospective study of children ≤ 12 y admitted with MIS-C (WHO definition) or laboratory-confirmed dengue between August 2020 and January 2021 at a tertiary center in North India.

RESULTS

A total of 84 children (MIS-C - 40; dengue - 44) were included. The mean (SD) age [83.5 (39) vs. 91.6 (35) mo] was comparable. Rash (72.5% vs. 22.7%), conjunctival injection (60% vs. 2.3%), oral mucocutaneous changes (27.5% vs. 0) and gallop rhythm (15% vs. 0) were seen more frequently with MIS-C, while petechiae [29.5% vs. 7.5%], myalgia (38.6% vs. 10%), headache (22.7% vs. 2.5%), and hepatomegaly (68.2% vs. 27.5%) were more common with dengue. Children with MIS-C had significantly higher C-reactive protein (124 vs. 3.2 mg/L) and interleukin 6 (95.3 vs. 20.7 ng/mL), while those with dengue had higher hemoglobin (12 vs. 10.2 g/dL) lower mean platelet count (26 vs. 140 × 10⁹/L), and greater elevation in aspartate (607 vs. 44 IU/L) and alanine (235.5 vs. 56 IU/L) aminotransferases. The hospital stay was longer with MIS-C; however, PICU stay and mortality were comparable.

CONCLUSION

In hospitalized children with acute febrile illness, the presence of mucocutaneous features and highly elevated CRP could distinguish MIS-C from dengue. The presence of petechiae, hepatomegaly, and hemoconcentration may favor a diagnosis of dengue.