Retropharyngeal Edema and Neck Pain in Multisystem Inflammatory Syndrome in Children (MIS-c)

Jenkins, Elan; Sherry, Whitney; Smith, Alison G C; Rostad, Bradley S.; Rostad, Christina A.; Jones, Kaitlin; Jaggi, Preeti

doi:10.1093/jpids/piab050

Cited by 18 publications

(21 citation statements)

References 13 publications

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“…Interestingly, it seems that many clinicians around the world have questioned the link between MIS-C and retropharyngeal phlegmon. One study suggests that 28% of patients diagnosed with MIS-C at their institution had neck complaints due to retropharyngeal edema [ 19 ]. Even though most of these patients received antimicrobials in addition to anti-inflammatory treatment, retrospective reviews suggested that the retropharyngeal edema was inflammatory rather than infectious [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…One study suggests that 28% of patients diagnosed with MIS-C at their institution had neck complaints due to retropharyngeal edema [ 19 ]. Even though most of these patients received antimicrobials in addition to anti-inflammatory treatment, retrospective reviews suggested that the retropharyngeal edema was inflammatory rather than infectious [ 19 ]. It is worth noting that otolaryngologic manifestations such as retropharyngeal edema may often be overlooked during the exclusionary process of MIS-C diagnosis and not be considered one of the organ systems with inflammation.…”

Section: Discussionmentioning

confidence: 99%

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A Mysterious Fever and Retropharyngeal Edema on a Previously Healthy 10-Year-Old Boy Without Known Exposure to COVID-19

Zhou¹,

Cheng²,

Hong³

2022

Cureus

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Multisystem inflammatory syndrome in children (MIS‐C) is considered a late manifestation of COVID-19 infection, and it is a diagnosis of exclusion after ruling out other causes of systemic inflammations. We present a case of MIS-C to highlight the importance of cardiac workup in MIS-C due to frequent cardiac involvement and discuss the possible association between retropharyngeal edema and MIS-C. The case patient is a 10-year-old previously healthy boy who presented with persistent fever, right-side neck pain, and a new rash. The rash was attributed to recent amoxicillin use by his parents. Pertinent workups included elevated inflammatory markers, a benign electrocardiogram test, a negative urine analysis, blood culture, and retropharyngeal edema by computerized tomography. On day four of hospitalization, the patient failed to improve with broad-spectrum antibiotics and became tachycardic. A repeat echocardiogram revealed a decreased ejection fraction with mitral valve regurgitation. The cardiac finding, the skin finding, the persistent fever, and the initial negative workups fulfilled the case criteria for MIS-C. A positive test for anti-SARS-CoV-2 spike protein receptor-binding domain antibodies confirmed the diagnosis, and the patient improved with intravenous immune globulin (IVIG) and steroids. The retropharyngeal edema was thought to be coincidental; however, there seem to be frequent associations between MIS-C and retropharyngeal edema, suggesting that the retropharyngeal edema could be one of the initial manifestations of MIS-C. More study is needed to study the association between retropharyngeal edema and MIS-C and shed light on the diagnosis and medical management of MIS-C.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Mysterious Fever and Retropharyngeal Edema on a Previously Healthy 10-Year-Old Boy Without Known Exposure to COVID-19

Zhou¹,

Cheng²,

Hong³

2022

Cureus

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“…Her CT scan nding of retropharyngeal uid collection led to treatment for septic shock in the setting of a retropharyngeal abscess as the alternative diagnosis, and she was treated accordingly. Cases of MIS-C with retropharyngeal edema and/or phlegmon have been reported, though they are neither common nor de ning features of MIS-C (3,4). Antibodies against SARS-CoV-2 viral spike proteins are elicited by vaccines and confer immunity, whereas COVID-19 antibody tests that detect nucleocapsid proteins of the SARS-CoV-2 virus indicate natural infection (15).…”

mentioning

confidence: 99%

Multisystem Inflammatory Syndrome in a Fully Vaccinated 18-Year-Old Without Known SARS-CoV-2 Infection

Liu

Love

Katz

et al. 2022

Preprint

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Background Multisystem inflammatory syndrome in children (MIS-C) is a febrile syndrome that is observed in the pediatric population following severe acute respiratory syndrome 2 (SARS-CoV-2) infection. Vaccines have prevented or lessened the severity of the initial acute respiratory infection, while their effectiveness against severe MIS-C is just beginning to be reported. Case presentation Here we report a fully vaccinated teenage female with no known history of SARS-CoV-2 infection who presented with shock and heart failure. Her presentation was initially thought secondary to a retropharyngeal abscess but was later identified as MIS-C after confirmed nucleocapsid antibody. Conclusions Given the recent Omicron wave, the ongoing international outbreaks with the BA.2 subvariant and the continued evolution of the COVID-19 pandemic, this case emphasizes the need to include MIS-C in the differential diagnosis, even in a fully vaccinated, previously healthy child.

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“…Neck pain has been reported in more than one-quarter of children with MIS-C, along with other otolaryngologic symptoms such as neck swelling, dysphagia, trismus, stridor and drooling [ 115 – 117 ]. Cervical imaging with US or contrast-enhanced CT might be requested to assess for signs of inflammation.…”

Section: Imaging Findings In Multisystem Inflammatory Syndrome In Chi...mentioning

confidence: 99%

“…Cervical imaging with US or contrast-enhanced CT might be requested to assess for signs of inflammation. The most common abnormalities are retropharyngeal edema and cervical lymphadenopathy [ 14 , 22 , 80 , 81 , 115 , 118 ] (Fig. 15 ).…”

Section: Imaging Findings In Multisystem Inflammatory Syndrome In Chi...mentioning

confidence: 99%

Imaging findings in acute pediatric coronavirus disease 2019 (COVID-19) pneumonia and multisystem inflammatory syndrome in children (MIS-C)

et al. 2022

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The two primary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are acute coronavirus disease 2019 (COVID-19) pneumonia and multisystem inflammatory syndrome (MIS-C). While most pediatric cases of acute COVID-19 disease are mild or asymptomatic, some children are at risk for developing severe pneumonia. In MIS-C, children present a few weeks after SARS-CoV-2 exposure with a febrile illness that can rapidly progress to shock and multiorgan dysfunction. In both diseases, the clinical and laboratory findings can be nonspecific and present a diagnostic challenge. Thoracic imaging is commonly obtained to assist with initial workup, assessment of disease progression, and guidance of therapy. This paper reviews the radiologic findings of acute COVID-19 pneumonia and MIS-C, highlights the key distinctions between the entities, and summarizes our understanding of the role of imaging in managing SARS-CoV-2-related illness in children.

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Retropharyngeal Edema and Neck Pain in Multisystem Inflammatory Syndrome in Children (MIS-c)

Cited by 18 publications

References 13 publications

A Mysterious Fever and Retropharyngeal Edema on a Previously Healthy 10-Year-Old Boy Without Known Exposure to COVID-19

A Mysterious Fever and Retropharyngeal Edema on a Previously Healthy 10-Year-Old Boy Without Known Exposure to COVID-19

Multisystem Inflammatory Syndrome in a Fully Vaccinated 18-Year-Old Without Known SARS-CoV-2 Infection

Imaging findings in acute pediatric coronavirus disease 2019 (COVID-19) pneumonia and multisystem inflammatory syndrome in children (MIS-C)

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