Table 3.
Comparing clinical signs and symptoms, lab and imaging, and treatment and outcome for two cases of MIS-C.
| Case 1 | Case 2 | ||
|---|---|---|---|
| Characteristics | |||
| Gender | Male | Female | |
| Age (years) | 15 | 14 | |
| 1 st admission | 2 nd admission | ||
| Weight (kg) | 60 | 67 | 50 |
| BMI (kg/m2) | 19.59 | 21.88 | 34.72 |
|
| |||
| Signs and symptoms | |||
| Fever | Yes | No | Yes |
| Cough, dyspnea | Yes | Yes | Yes |
| Sore throat | No | No | Yes |
| Decreased appetite | No | Yes | Yes |
| Nausea, vomiting | No | No | No |
| Diarrhoea | No | No | Yes |
| Fatigue | Yes | Yes | Yes |
| Headache | Yes | No | Yes |
| Rash | Yes | No | Yes |
| Desaturation <92% | No | Yes | Yes |
| Edema | No | Yes | Yes |
|
| |||
| PICU referral | |||
| Reason of referral | No PICU referral | Respiratory deterioration | Respiratory distress and excessive edema with early signs of shock |
| Organ support | None | NIV | Oxygen therapy through nasal cannula |
| Pharmacological treatment | None | Vasopressins, antibiotics, diuretics, morphin | Antibiotics, antipyretics, diuretics, intravenous immunoglobulins |
| LOS in hospital | 10 | 28 | 23 |
| LOS in PICU | 0 | 7 | 10 |
|
| |||
| Imaging result | |||
| Chest X-ray | Normal | Bilateral consolidations | Consolidation left upper lobe |
| Chest CT | No | Bilateral consolidations | Pericarditis and bilateral consolidations |
| Heart ultrasound | No | (i) Dilated left ventricle, ejection fraction 30–35%. (ii) Diastolic dysfunction grade 1 (iii) Normal right ventricle (iv) Dilated left atrium (v) MI 2/4, TI 1/4, dilated truncus pulmonalis (vi) Pericardial effusion (5 mm), no hemodynamical consequences |
(i) Pericarditis with pericardial effusion 15 mm, no hemodynamical consequences |
| ECG | Normal | Negative T-waves in the anterior wall with prolonged QT-segment (534 ms) | Peripheral low voltages with flattened T-waves in left precordials |
|
| |||
| Lab results | (i) Lymphopenia (929/mm³) (ii) Thrombocytopenia (116.000/mm³) (iii) CRP 30 mg/L (maximum) (iv) Albumin 31 g/L (v) Normal hepatic enzymes |
(i) No lymphopenia/leukopenia (ii) No thrombocytopenia or thrombocytosis (iii) Anemia: hemoglobin 7.3 g/dL (iv) CRP 56.6 mg/L (v) Albumin 26 g/L (vi) Normal hepatic enzymes (vii) Cardiac enzymes: (a) NT-proBNP 155919.0 ng/L (b) Cardiac troponin T 0.314 µg/L (viii) D-dimer 6943 ng/ml (ix) Fibrinogen 482 mg/dL |
(i) Lymphopenia (267/mm³) (ii) Thrombocytosis (808.000/mm³) (iii) Hemoglobin 7.6 g/dL (iv) CRP 304.3 mg/L (maximum) (v) Albumin 24 g/L (vi) Cardiac enzymes: (a) NT-proBNP 3228.0 ng/L (b) Cardiac troponin 0.01 mcg/L (vii) D-dimer 3584 ng/ml (viii) Fibrinogen 322 mg/dL |
|
| |||
| Microbiology results | (i) Nasopharyngeal swab: PCR SARS-CoV-2 positive | (i) Nasopharyngeal swab: PCR SARS-CoV-2 negative (ii) Heart biopsy: PCR SARS-CoV-2 negative (iii) SARS-CoV-2 IgG ELISA positive (54.30 AE/mL) |
(i) Nasopharyngeal swab: PCR SARS-CoV-2 negative (twice) (ii) SARS-CoV-2 IgG ELISA positive (41.30 AE/mL) |