1. PATIENT PRESENTATION
A previously healthy 10‐year‐old boy presented to the emergency department (ED) with 3 days of fever, nausea, vomiting, and diarrhea. He was found to have a temperature of 39.6°C, heart rate (HR) 128, blood pressure (BP) 126/77. He was well appearing, and his exam was normal. He was sent home with a diagnosis of viral syndrome and gastroenteritis. He returned the next day with the previous complaints but with a new rash involving the hands and feet (Figures 1 and 2), complaints of a sore throat, and cracked lips (Figure 3). Vitals on the second presentation were temperature of 38.2°C, HR 108, and BP 105/60. Exam now showed a fine rash on the palms more than the soles and dry, cracked lips. No adenopathy or conjunctivitis was present. Bloodwork was obtained showing a total white count of 13.2 (10.7 neutrophils, 0.7 lymphocytes), erythrocyte sedimentation rate of 32 (normal <10), and C‐reactive protein 13.1 (normal <1). His coronavirus disease (COVID) polymerase chain reaction test was negative.
FIGURE 1.
The patient's palms
FIGURE 2.
The dorsa of the patient's hands
FIGURE 3.
The patient's dry, red lips
On further history, the entire family had been ill with a non‐specific viral syndrome 4 weeks prior, none of whom sought medical attention or testing, and all recovered.
2. DIAGNOSIS
2.1. Multisystem inflammatory syndrome in children (MIS‐C)
He was admitted to the hospital with a diagnosis of multisystem inflammatory syndrome in children (MIS‐C). Immunoglobulin G to the COVID spike protein was positive. He underwent cardiac echocardiography, which was without abnormality, including any evidence of coronary aneurysm. He was treated with intravenous immunoglobulin and steroids with resolution of his symptoms and discharged after 5 days in the hospital.
MIS‐C is an illness that mimics Kawasaki's disease and affects children (peak age 10, but with a wide range) several weeks after having COVID. The clinical course of MIS‐C varies from mild to profound shock. Similar to Kawasaki's disease, echocardiography should be performed to evaluate for myocarditis or coronary aneurysms.
Perera NM, Gailey S. A child with fever, vomiting, diarrhea, and rash. JACEP Open. 2022;3:e12663. 10.1002/emp2.12663