A Case of Multisystem Inflammatory Syndrome in Children Mimicking Acute Appendicitis in a COVID-19 Pandemic Area

Abstract

The outbreak of the novel coronavirus (2019-nCoV) began in Wuhan, China and spread rapidly throughout the world. As of now, there have been numerous reports demonstrating clinical, radiological and pathological findings in adults. In children, the disease has essentially been seen as mild and self-limiting. However, more recently, children have been presenting with findings reminiscent of Kawasaki's disease. And secondary to this, the benign nature of COVID-19 disease in children is beginning to be challenged. This phenomenon is now referred to as multisystem inflammatory syndrome in children (MIS-C). Further understanding the clinical course in MIS-C and its temporal association with coronavirus disease 2019 will be paramount for treatment and public health decision making. This correspondence describes a case of MIS-C with gastrointestinal manifestations mimicking acute appendicitis in a child presenting from a COVID-19 endemic area.

Keywords: covid 19; mimicker; mis-c.

Figure 1. Radiology Findings

A: Initial right lower quadrant abdomen ultrasound suspicious for an acute appendicitis, B: CT scan status post appendectomy and terminal ileum resection showing postsurgical changes in the right anterior abdominal wall, C: Postsurgical ultrasound showing a small amount of free fluid and inflammatory changes in the right lower quadrant.

Figure 2. Pathology Findings on Hematoxylin and Eosin Stained Tissues

A: Peyer's patches showing hyperplastic lymphoid tissue, B: Small bowel and appendix with extensive subserosal edema, C: Mesenteric lymph node with necrotizing lymphadenitis, D: Acute vasculitis of mesenteric arteries and veins (inset with arrow identifying neutrophil).