Multisystem Inflammatory Syndrome in Children (MIS-C) with Involvement of Cardiovascular, Respiratory, and Gastrointestinal System: A Case Report

https://doi.org/10.25143/rsu-bjcmr.2024.01.023-025

Abstract

MIS-C is a rare complication after COVID-19 that develops because of a dysregulated immune response with an excessive inflammatory response. The definition of MIS-C is based on the following criteria: age of 0-19 years, presence of fever for more than 3 days, involvement of more than two organ systems, elevated inflammatory markers, evidence of COVID-19 infection, and exclusion of differential diagnosis.

This is a case of a 7-year-old female patient who presented to the emergency department with complaints of fever, headache, jaundice, fatigue, and nausea for two days. Physical examination revealed icterus, abdominal pain, hepatomegaly, and palmar erythema. Laboratory results showed leucopenia 3.29 x10 3 /uL, thrombocytopenia 58 x103 /uL, prolonged prothrombin time 48.2 %, INR 1.55, high ferritin 3278 ng/mL, bilirubin 117.34 umol/L, ALT 2003.11 U/L, AST 2224.82, LDH 1165 U/L, D-dimers 4.63 mg/L FEU, creatinine 31.85 umol/L, CRP 50.57 mg/L and NT-ProBNP 504.4 pg/ml. Ultrasonography showed polyserositis, ascites, pericholecystitis, hepatolienal syndrome, fluid accumulation in pleural space, pericardial effusion, tricuspid, and mitral valve insufficiency.  It was found that the patient has SARS-CoV-2 spike (s) protein antibodies and IgG against adenovirus. Differential diagnosis of adenovirus associated acute hepatitis was excluded. Thereafter patient was diagnosed with MIS-C with involvement of liver, lungs, and heart. Treatment with immunoglobulins, furosemide, spironolactone, low dose methylprednisolone and aspirin was started. After 12 days of hospitalization patient’s condition normalized and she was discharged home with recommended follow-up. 

The diagnosis of MIS-C is challenging due to the wide variety of clinical and laboratory manifestations. The initiation of immunoglobulin therapy is crucial for recovery of patient and should not be delayed as soon as there’s a diagnostic suspicion.