Multisystem Inflammatory Syndrome in Children Temporally Related to COVID-19: A Case Report From Saudi Arabia

Abstract

The World Health Organization is still revising the epidemiology of multi-system inflammatory syndrome in children (MIS-C) and the preliminary case definition, although there is a dearth of robust evidence regarding the clinical presentations, severity, and outcomes. Researchers, epidemiologists, and clinicians are struggling to characterize and describe the disease phenomenon while taking care of the diseased persons at the forefronts. This report tackles the first case of a 13-year-old Saudi female with the MIS-C mimicking Kawasaki disease. Her main manifestations were fever, gastrointestinal symptoms, evidence of organ failure with an increase in inflammatory markers, and a history of coronavirus disease (COVID-19) infection. She had glucose-6-phosphate dehydrogenase (G6PD) deficiency and no significant previous history of any disease. She presented with signs of acute illness: high-grade fever (39.6°C) for five days accompanied by sore throat, malaise, reduced oral intake, abdominal pain, diarrhea, skin rash, bilateral non-suppurative conjunctivitis, and erythematous, cracked lips. Eventually, she died despite aggressive management based on the Centers for Disease Control and Prevention and the Saudi Ministry of Health guidelines for COVID-19 management. Based on this case, we suggest that pediatricians need to be aware of such atypical presentations and early referral to tertiary care is imperative for further early diagnosis and management. MIS-C is a rare yet severe and highly critical complication of COVID-19 infection in pediatrics, leading to serious and life-threatening illnesses. Knowledge about the wide spectrum of presenting signs and symptoms and disease severity, including early detection and treatment, is pivotal to prevent a tragic outcome.

Multisystem inflammatory syndrome in children. An emerging clinical challenge for pediatric surgeons in the COVID 19 era

“…Moreover, a diagnosis of mesenteric adenitis in MIS-C has been accounted by 8 case-series, with a prevalence of 9–20% of the abdominal imaging studies [ 6 , 8 , 13 , 16 , 23 , 27 , 31 , 32 ]. In addition, the latter condition has been also described in six recent case-reports from different geographic areas [ 9 , 25 , 26 , 30 , 33 , 34 ]: notably, in one of those patients mesenteric lymphadenitis was even confirmed on surgical specimens by pathologists [ 9 ].…”

COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a case series from a tertiary care pediatric hospital in Qatar

“…[4] The true incidence of MIS-C is still uncertain but an estimated incidence of 0.6% among laboratory con rmed COVID-19 patients has been reported in New York. [5] To date, the majority of MIS-C cases have been reported from North America and European countries with very few reports from Asian countries [4][5][6][7][8][9]. Large case series conducted in the USA and UK show that risks associated with developing MIS-C may vary by gender, age and ethnicity.…”

COVID-19 Pediatric Dermatology

“…The hands and feet are frequently a site of cutaneous symptoms; findings include erythema, swelling (edema), and desquamation. 28 , 38 , 39 , 40 Mucositis in the forms of papillitis of the tongue (strawberry tongue), 29 , 41 cheilitis (lips appearing erythematous, swollen, dry, or cracked/fissured), 28 , 39 , 40 , 42 and/or conjunctivitis 29 , 41 are frequently observed.…”

“… 25 The median hospital stay is about 1 week, 24 and the large majority of MIS-C children enter remission. However, there have been reports of death due to MIS-C following COVID-19 infection; 24 , 42 mortality is estimated at 2%. 24 , 26 …”