Suzuki Takanori, Kono Toya, Satoshi Hisada, Uchida Hidetoshi, Ota Seiichiro, Tateya Ichiro, Yoshikawa Tetsushi
Department of Pediatrics, School of Medicine, Fujita Health University, Aichi, Japan.
Department of Otorhinolaryngology, School of Medicine, Fujita Health University, Aichi, Japan.
Front Pediatr. 2023 Jul 18;11:1198505. doi: 10.3389/fped.2023.1198505. eCollection 2023.
Multisystem inflammatory syndrome in children (MIS-C) has been widely reported, mainly in Western countries. The clinical features of MIS-C and Kawasaki disease are similar. The latter is common in Asian countries, including Japan. Meanwhile, the incidence of MIS-C seems to be low in Japan. Retropharyngeal edema is relatively common in older patients with Kawasaki disease and has been reported in a few patients with MIS-C. We describe a case of severe retropharyngeal edema after coronavirus disease 2019 (COVID-19) that improved quickly with high-dose of intravenous immunoglobulin treatment. Onset of retropharyngeal edema was 3 weeks after COVID-19. The patient received appropriate intravenous antibiotics for 5 days, but his symptoms worsened. Therefore, we suspected that his retropharyngeal edema was caused by suspected MIS-C even though he did not have the typical clinical symptoms of suspected MIS-C such as gastrointestinal symptoms and shock. Retropharyngeal edema was refractory to antibiotic therapy but lessened quickly with high-dose immunoglobulin therapy, without other typical clinical manifestations of MIS-C, suggesting that early immunoglobulin therapy might prevent the progression of MIS-C.
儿童多系统炎症综合征（MIS-C）已被广泛报道，主要见于西方国家。MIS-C与川崎病的临床特征相似。后者在包括日本在内的亚洲国家很常见。与此同时，MIS-C在日本的发病率似乎较低。咽后水肿在年长的川崎病患者中相对常见，少数MIS-C患者也有相关报道。我们描述了1例2019冠状病毒病（COVID-19）后出现严重咽后水肿的病例，该病例经大剂量静脉注射免疫球蛋白治疗后迅速好转。咽后水肿在COVID-19后3周出现。患者接受了5天的适当静脉抗生素治疗，但症状恶化。因此，尽管该患者没有疑似MIS-C的典型临床症状，如胃肠道症状和休克，但我们怀疑其咽后水肿是由疑似MIS-C引起的。咽后水肿对抗生素治疗无效，但大剂量免疫球蛋白治疗后迅速减轻，且无MIS-C的其他典型临床表现，这表明早期免疫球蛋白治疗可能预防MIS-C的进展。
