Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Pediatr Infect Dis J. 2021 Feb 1;40(2):e72-e76. doi: 10.1097/INF.0000000000002978.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), an entity in children initially characterized by milder case presentations and better prognoses as compared with adults. Recent reports, however, raise concern for a new hyperinflammatory entity in a subset of pediatric COVID-19 patients.
We report a fatal case of confirmed COVID-19 with hyperinflammatory features concerning for both multi-inflammatory syndrome in children (MIS-C) and primary COVID-19.
This case highlights the ambiguity in distinguishing between these two entities in a subset of pediatric patients with COVID-19-related disease and the rapid decompensation these patients may experience.
Appropriate clinical suspicion is necessary for both acute disease and MIS-C. SARS-CoV-2 serologic tests obtained early in the diagnostic process may help to narrow down the differential but does not distinguish between acute COVID-19 and MIS-C. Better understanding of the hyperinflammatory changes associated with MIS-C and acute COVID-19 in children will help delineate the roles for therapies, particularly if there is a hybrid phenotype occurring in adolescents.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引起 2019 年冠状病毒病（COVID-19），在儿童中最初表现为较轻的病例和较好的预后，与成人相比。然而，最近的报告引起了人们对儿童 COVID-19 患者亚群中一种新的高炎症实体的关注。
我们报告了一例确诊的 COVID-19 伴有高炎症特征的病例，令人担忧的是既存在儿童多系统炎症综合征（MIS-C），也存在原发性 COVID-19。
该病例突出表明，在 COVID-19 相关疾病的儿童亚群中，区分这两种实体存在一定的模糊性，这些患者可能会迅速恶化。
对于急性疾病和 MIS-C，都需要有适当的临床怀疑。在诊断过程中尽早获得 SARS-CoV-2 血清学检测结果可能有助于缩小鉴别范围，但不能区分急性 COVID-19 和 MIS-C。更好地了解与 MIS-C 和急性 COVID-19 相关的高炎症变化将有助于阐明治疗方法的作用，特别是如果青少年中存在混合表型。
