Almatrafi Mohammed A, Kabli Abdulrahman F, Subahi Yara, Yaseen Esraa, Alsahaf Nouf, Alidrisi Dhuha, Ahmed Hanan A, Masmali Hassan M, Alahmad Ossamah, Khan Mohammad N, Minshawi Faisal
Department of Pediatrics, Umm Al-Qura University, Makkah, SAU.
Department of Medicine, Umm Al-Qura University, Makkah, SAU.
Cureus. 2022 Oct 29;14(10):e30832. doi: 10.7759/cureus.30832. eCollection 2022 Oct.
Multisystem inflammatory syndrome in children (MIS-C) can develop weeks after the Coronavirus disease 2019 (COVID-19). The disease's clinical spectrum includes persistent febrile illness, features resembling Kawasaki disease, and cytokine storm symptoms. In severe cases, multisystem organ failure and death may result if not treated promptly. This report discusses a rare case of a 13-year-old girl presenting with fever and acute kidney injury (AKI) eight weeks after recovering from COVID-19 who was diagnosed with MIS-C. A 13-year-old female presented with a fever and abdominal pain following a recent COVID-19. A physical examination revealed a febrile, ill-looking child with abdominal tenderness. Pancytopenia, transaminitis, AKI, and a hyperinflammatory state were noted in the initial laboratory workup. Furthermore, blast cells were seen on the peripheral blood smear. Despite appropriate empiric antibiotic therapy for sepsis, she did not show signs of clinical improvement. An abdominal computed tomography (CT) scan revealed multiple focal areas of hypoattenuating lesions involving both kidneys, suggestive of bilateral renal infarction. Since she met the criteria of the Centers for Disease Control and Prevention (CDC) for MIS-C diagnosis, a high dose of intravenous immunoglobulin (IVIG) led to a dramatic improvement in the patient's condition and complete recovery from her illness. This case report describes a rare clinical presentation of MIS-C in a child who presented with AKI due to presumably thrombotic events and transient blast cells in blood film secondary to a severe inflammatory process. Further studies are needed to determine the prevalence of thrombotic AKI associated with MIS-C.
儿童多系统炎症综合征（MIS-C）可在2019冠状病毒病（COVID-19）感染数周后出现。该疾病的临床谱包括持续性发热性疾病、类似川崎病的特征以及细胞因子风暴症状。在严重情况下，如果不及时治疗，可能会导致多系统器官衰竭和死亡。本报告讨论了一例罕见病例，一名13岁女孩在COVID-19康复8周后出现发热和急性肾损伤（AKI），被诊断为MIS-C。一名13岁女性在近期感染COVID-19后出现发热和腹痛。体格检查发现患儿发热、面容不佳且有腹部压痛。初始实验室检查发现全血细胞减少、转氨酶升高、AKI和高炎症状态。此外，外周血涂片可见原始细胞。尽管对脓毒症进行了适当的经验性抗生素治疗，但她没有显示出临床改善的迹象。腹部计算机断层扫描（CT）显示双侧肾脏有多个低密度病灶的局灶性区域，提示双侧肾梗死。由于她符合美国疾病控制与预防中心（CDC）的MIS-C诊断标准，高剂量静脉注射免疫球蛋白（IVIG）使患者病情显著改善并完全康复。本病例报告描述了MIS-C在一名儿童中的罕见临床表现，该患儿因可能的血栓形成事件以及严重炎症过程导致血片中出现短暂原始细胞而出现AKI。需要进一步研究以确定与MIS-C相关的血栓性AKI的患病率。
