Multisystem inflammatory syndrome in children (MIS-C) is a potentially life-threatening consequence of coronavirus disease (COVID-19) infection characterized by hyperinflammatory state, leading to multi-organ damage that often requires hospitalization. Though the precise underlying etiopathogenesis of MIS-C is not completely comprehended, the correlation between MIS-C and COVID-19 infection implies a delayed immune response dysregulation in the post-COVID-19 infection setting. MIS-C patients may have a wide spectrum of manifestations including fever, elevated inflammatory parameters and signs of end organ damage including myocarditis, cardiac disfunction, gastrointestinal manifestations, respiratory impairment, acute kidney injury, and/or hematologic, dermatologic and/or neurological involvement. Although MIS-C may overlap with other well understood hyperinflammatory conditions such as secondary hemophagocytic lymphohistiocytosis (SHLH) in several Clinical features and laboratory findings, striking manifestations including Gastrointestinal and cardiac ones make the direction of the diagnostic compass geared more towards MIS-C which are unusual components of disease process in SHLH. Besides that, MIS-C can be distinguished from SHLH in the amplitude and severity of hyperinflammation, which are more pronounced in SHLH. Because of the overlap, diagnosis of MIS-C requires a high clinical index as prompt recognition and early intervention have favorable prognostic outcomes. We herein report a 5-year-old male child patient who presented with overlapping features between MIS-C and SHLH in a post-COVID-19 setting.
Introduction: The caudal and basal parts of the lungs are fused together in a rare congenital bronchopulmonary anomaly known as horseshoe lung. The majority of horseshoe lung cases are associated with scimitar syndrome. Most patients present with nonspecific symptoms. Multidetector pneumoangiography can be used to diagnose horseshoe lung, which shows that the isthmus of the pulmonary parenchyma traverses the midline, connecting the two lungs together. Treatment and prognosis are usually determined depending on the presence of other concomitant anomalies and the degree of symptom severity. Case Presentation: A 3-month-old-male patient presented with respiratory symptoms and a history of chest infection. Chest imaging revealed anomalous venous drainage from the right lower lobe of the lung, right lung hypoplasia with mediastinal shift, and a parenchymal isthmus extending between the two lungs. The patient was diagnosed with horseshoe lungs associated with scimitar syndrome. He was also found to have extralobar sequestration to the right lower lobe of the lung. The patient underwent surgical management in the form of tunneling of the anomalous vein into the left atrium using pericardium autograft ligation of the sequestration artery. Clinical Discussion: Because of its common association with other congenital malformations such as scimitar syndrome and cardiovascular defects, clinicians should be meticulous in the investigation and workup process of patients with horseshoe lung in order not to miss any of these associated abnormalities. Conclusion: Although it is very rare, horseshoe lung should be considered in the differential diagnosis of respiratory distress symptoms, especially in children younger than 1 year.
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