Mesenteric Lymphadenitis Presenting as Acute Abdomen in a Child with Multisystem Inflammatory Syndrome

Abstract

Multisystem inflammatory syndrome in children (MIS-C) may develop as a rare complication following COVID-19. MIS-C presentation varies substantially, but fever and gastrointestinal symptoms are the most prominent. Indeed, gastrointestinal involvement may be severe enough to present as acute abdomen, posing challenges to clinicians. We present herein the case of a healthy five-year-old male who presented with fever, vomiting, and abdominal pain, resembling acute abdomen. The patient had no history of SARS-CoV-2 infection or exposure, and MIS-C diagnosis was initially surpassed unnoticed. The patient underwent exploratory laparotomy that only revealed mesenteric lymphadenitis. Postoperatively, the patient met the clinical and laboratory diagnostic criteria of MIS-C. SARS-CoV-2 exposure was serologically confirmed and MIS-C treatment was commenced, resulting in defervescence and a satisfactory outcome. In young patients presenting with acute abdomen, surgeons should be aware of MIS-C, so that earlier diagnosis and appropriate treatment are made prior to surgical interventions.

A cursed goodbye kiss from severe acute respiratory syndrome-coronavirus-2 to its pediatric hosts: multisystem inflammatory syndrome in children

“…Following the disease definition, fever, rash, cardiac, and GIS involvement signs were reported to be the most common clinical findings of MIS-C, in several cohort studies [14,15 & ,47, [55][56][57][58]. We tried to summarize the main characteristics of MIS-C patients in Table 1 There are also other miscellaneous cases whose cardinal signs have been uncommon such as acute pancreatitis, encephalopathy, cerebellitis, diabetic ketoacidosis, hepatitis, acute appendicitis, mesenteric lymphadenopathy, ocular myasthenia, and papilledema [70][71][72][73][74][75][76][77][78]. Despite the common similarities between Kawasaki disease and MIS-C, only one MIS-C case has been reported to have erythema and induration of Bacillus Calmette-Guerin (BCG) scar so far [79].…”

“…There are also other miscellaneous cases whose cardinal signs have been uncommon such as acute pancreatitis, encephalopathy, cerebellitis, diabetic ketoacidosis, hepatitis, acute appendicitis, mesenteric lymphadenopathy, ocular myasthenia, and papilledema [70–78]. Despite the common similarities between Kawasaki disease and MIS-C, only one MIS-C case has been reported to have erythema and induration of Bacillus Calmette–Guerin (BCG) scar so far [79].…”