Zhou Chenxuan, Cheng Mengyao, Hong Hanyang
Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, USA.
Department of Nursing, J. Sargeant Reynolds Community College, Richmond, USA.
Cureus. 2022 May 26;14(5):e25373. doi: 10.7759/cureus.25373. eCollection 2022 May.
Multisystem inflammatory syndrome in children (MIS-C) is considered a late manifestation of COVID-19 infection, and it is a diagnosis of exclusion after ruling out other causes of systemic inflammations. We present a case of MIS-C to highlight the importance of cardiac workup in MIS-C due to frequent cardiac involvement and discuss the possible association between retropharyngeal edema and MIS-C. The case patient is a 10-year-old previously healthy boy who presented with persistent fever, right-side neck pain, and a new rash. The rash was attributed to recent amoxicillin use by his parents. Pertinent workups included elevated inflammatory markers, a benign electrocardiogram test, a negative urine analysis, blood culture, and retropharyngeal edema by computerized tomography. On day four of hospitalization, the patient failed to improve with broad-spectrum antibiotics and became tachycardic. A repeat echocardiogram revealed a decreased ejection fraction with mitral valve regurgitation. The cardiac finding, the skin finding, the persistent fever, and the initial negative workups fulfilled the case criteria for MIS-C. A positive test for anti-SARS-CoV-2 spike protein receptor-binding domain antibodies confirmed the diagnosis, and the patient improved with intravenous immune globulin (IVIG) and steroids. The retropharyngeal edema was thought to be coincidental; however, there seem to be frequent associations between MIS-C and retropharyngeal edema, suggesting that the retropharyngeal edema could be one of the initial manifestations of MIS-C. More study is needed to study the association between retropharyngeal edema and MIS-C and shed light on the diagnosis and medical management of MIS-C.
儿童多系统炎症综合征（MIS-C）被认为是新冠病毒感染的一种晚期表现，是在排除其他全身性炎症原因后作出的排除性诊断。我们报告一例MIS-C病例，以强调由于心脏常受累，心脏检查在MIS-C中的重要性，并讨论咽后水肿与MIS-C之间可能的关联。该病例患者是一名10岁以前健康的男孩，出现持续发热、右侧颈部疼痛和新发皮疹。其父母将皮疹归因于近期使用阿莫西林。相关检查包括炎症指标升高、心电图检查正常、尿液分析阴性、血培养阴性以及计算机断层扫描显示咽后水肿。住院第4天，患者使用广谱抗生素后病情未改善且出现心动过速。复查超声心动图显示射血分数降低并伴有二尖瓣反流。心脏检查结果、皮肤表现、持续发热以及最初的阴性检查结果符合MIS-C的病例标准。抗SARS-CoV-2刺突蛋白受体结合域抗体检测呈阳性，确诊后患者接受静脉注射免疫球蛋白（IVIG）和类固醇治疗后病情好转。咽后水肿被认为是巧合；然而，MIS-C与咽后水肿之间似乎常有关联，提示咽后水肿可能是MIS-C的初始表现之一。需要更多研究来探讨咽后水肿与MIS-C之间的关联，并为MIS-C的诊断和医疗管理提供线索。
