Rationale
Florida is among the states with the highest COVID-19 disease burden in the country. We have seen an emergence of multi-system inflammatory syndrome in children (MIS-C), associated with COVID-19 infection in our region and successfully treated three patients in our hospital. Here, we describe the diagnosis and management of MIS-C in one of these patients.
Methods
COVID-19 associated MIS-C guidelines; A Western New York Approach (PMCID 7244417) criteria [Fever > 24 hours, illness requiring hospitalization, laboratory evidence of inflammation, > 2 organ system involvement and no alternative plausible diagnosis with COVID-19 positivity/exposure] and treatment recommendations were followed for the management of this patient.
Results
A 2-year-old African-American male presented with fever, rash, and bilateral eye redness for 5 days with prior SARS-COV-2 exposure confirmed by positive serum IgG. Clinical findings included features of a Kawasaki-disease (KD)-like illness with bilateral bulbar injection, pharyngitis, polymorphous rash, erythema of palms and soles, and unilateral cervical lymphadenopathy. He had elevated inflammatory markers, elevated D-dimer and fibrinogen, and hypoalbuminemia. He also had elevated brain natriuretic peptide with a normal echocardiogram, meeting MIS-C criteria of remote infection with predominant KD features. He was treated with low dose aspirin, IVIG, and intravenous methylprednisolone. He improved and was discharged after 7 days of hospitalization.
Conclusions
Recognition of MIS-C in its early stages is very critical, however, in the absence of standardized management guidelines, the treatment gets very challenging. Therefore, global reporting of the detection and management of these cases is essential for developing a definitive management standard.
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