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Case Reports
. 2023 Apr 17:11:1167828.
doi: 10.3389/fped.2023.1167828. eCollection 2023.

Case report: Multisystem inflammatory syndrome in children associated with COVID-19, macrophage activation syndrome, and incomplete Kawasaki disease

Jesús Javier Martínez-García  1   2 , Jesús Ramon López-Acosta  1 , Daniela Arce-Cabrera  3 , Nidia León-Sicairos  2   4 , Ana Cristina Hernández-Parra  1 , Hector Melesio Cuen-Diaz  5 , Ricardo Zatarain-Lopez  2 , Adrian Canizalez-Roman  2   6
Affiliations
Case Reports

Case report: Multisystem inflammatory syndrome in children associated with COVID-19, macrophage activation syndrome, and incomplete Kawasaki disease

Jesús Javier Martínez-García et al. Front Pediatr. .

Abstract

Background: Multisystem inflammatory syndrome in children (MIS-C), is a severe complication of coronavirus disease 2019 (COVID-19), characterized by persistent fever, systemic inflammatory response, and organ failure. MIS-C with a history of COVID-19 may share clinical features with other well-defined syndromes such as macrophage activation syndrome, Kawasaki disease, hemophagocytic syndrome and toxic shock syndrome.

Case 1: An 11-year-old male with a history of hypothyroidism and precocious puberty with positive antibody test for COVID-19 was admitted for fever, poor general condition, severe respiratory distress, refractory shock, and multiple organ failure. His laboratory examination showed elevated inflammatory parameters, and bone marrow aspirate showed hemophagocytosis.

Case 2: A 13-year-old male with a history of attention deficit hyperactivity disorder and cognitive delay presented clinical manifestations of Kawasaki disease, fever, conjunctival congestion, exanthema, and hyperemia in oral mucosa, tongue, and genitals, with refractory shock and multiple organ failure. Reverse transcriptase polymerase chain reaction (RT-PCR) and antibodies for COVID-19 were negative, inflammation parameters were elevated, and bone marrow aspirate showed hemophagocytosis. Patients required intensive care with invasive mechanical ventilation, vasopressor support, intravenous gamma globulin, systemic corticosteroids, low molecular weight heparin, antibiotics, and monoclonal antibodies and, patient 2 required renal replacement therapy.

Conclusions: Multisystemic inflammatory syndrome in children can have atypical manifestations, and identifying them early is very important for the timely treatment and prognosis of patients.

Keywords: COVID-19; Kawasaki disease (KD); SARS-CoV-2; macrophage activation syndrome (MAS); multisystemic inflammatory syndrome in children (MIS-C).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Maculopapular rash on the lower extremities.
Figure 2
Figure 2
(A) Bilateral nonsuppurative conjunctival injection; (B) hyperemic oral mucosa and tongue; and (C) erythematous maculopapular rash.
See this image and copyright information in PMC

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