Critical Cases - Multisystem Inflammatory Syndrome in Children!
- Initial sx 6 days prior: erythematous, cracked lips
- Presented to urgent care next day with fever and sore throat
- Noted to have a “strawberry tongue” on evaluation and started on Amoxicillin for possible strep pharyngitis
- Covid and strep tests sent: negative
- Day 3: developed whole body erythematous rash which resolved after 1-2 days
- Patient now with diffuse, intermittent, abdominal pain X 2 days ago w/vomiting and diarrhea
- Mother notes fatigue and decreased activity
- Of note, dad had COVID 3 weeks ago
- No urinary complaint
BP 112/55 | Pulse 118 | Temp 97.8 °F (36.6 °C) (Oral) | Resp 24 | SpO2 100%
General: In fetal position. Moaning. Fatigued
HEENT: +Strawberry tongue. No oropharyngeal exudates, erythema, lesions or swelling. Uvula midline without swelling. No cervical LAD
Eyes: Conjunctivae are normal.
Cardiovascular: Tachycardia. No murmurs.
Pulmonary: Lungs clear. No respiratory distress
Abdomen: Soft, bowel sounds are normal. Diffuse tenderness, worse in the RLQ. Negative Rovsing’s. Non-peritoneal.
- COVID with multi-systemic inflammatory syndrome
- Kawasaki syndrome
- CBC: WBC 24, 24% bands, plt 118
- BMP: BUN 58, Cr 1.41
- ESR: 27
- CRP: 32
- LFTs WNL
- Monospot: negative
- POC Covid: negative
- ECG: Sinus tachycardia. Rate 124. TWI V2. No STE or STD
- COVID PCR POSITIVE
- hsTrop: 145
- NT-proBNP: 10,815
- Lactate: 2.3
- D-dimer: 0.6
- Ferritin: 706
- UA unremarkable
- CXR unremarkable
- Repeat vitals: BP 85/49 | Pulse 122 | Temp 102 °F (38.9 °C) (Oral) | Resp 40 | SpO2 100%
- Reassessed, more ill-appearing w/ worsening vitals as above.
- Discussed with peds ID - agreed with suspected multi-system inflammatory syndrome from COVID.
- Transferred to peds tertiary care center for escalation of care: started on IVIG and high dose ASA there.
CDC Information for Multisystem Inflammatory Syndrome in Children (MIS-C)
- Suspect MIS-C in patients <21 with evidence of multisystem involvement, elevated inflammatory markers, and severe clinical illness in the setting of possible or confirmed Covid-19 infection or exposure within the last 4 weeks
- This is reportable to local and state health departments
- Consider early transfer to pediatric referral center