tetano
Editor, Senior Moderator
Cureus
. 2022 Jan 31;14(1):e21764.
doi: 10.7759/cureus.21764. eCollection 2022 Jan.
Challenges in Evaluating Pediatric Fever and Rash in the Era of COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C)
Taylor Jarvill[SUP] 1 [/SUP], Priyanka Lauber[SUP] 1 [/SUP], Samuel Umaru[SUP] 2 [/SUP], Tibisay Villalobos[SUP] 2 [/SUP], Susan K Yaeger[SUP] 1 [/SUP]
Affiliations
Abstract
Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged the medical community to characterize and treat a new illness. Now almost two years after the initial confirmed cases of COVID-19, medical teams are faced with another unique disease process temporally related to the pandemic-multisystem inflammatory syndrome in children (MIS-C). The comparison of these patients' presentations illustrates the new challenges of evaluating a pediatric rash and fever in the era of MIS-C.
Case reports: This report presents three cases with features of MIS-C, positivity for SARS-CoV-2, rashes, fevers, gastrointestinal involvement, and elevated inflammatory markers. The first case poses a diagnostic dilemma. While the case 1 patient has many features of MIS-C, his nasal swab was positive for Methicillin-sensitive Staphylococcus Aureus (MSSA). While the second case falls into the case definition of MIS-C, the case 2 patient also met the criteria for atypical Kawasaki disease. Although the third case was positive for SARS-CoV-2, the patient comparatively had a mild elevation of inflammatory markers and a stable clinical course led the treatment team to be more suspicious of immunoglobulin A (IgA) vasculitis versus hand, foot, and mouth disease. The variability in skin rash in patients with MIS-C contributes to the challenge of correctly diagnosing and managing pediatric patients with fever and rash in the emergency department (ED).
Conclusion: Although most children infected with SARS-CoV-2 are asymptomatic or present with mild respiratory illness, it is critical to recognize children at-risk for fluid-refractory shock in MIS-C. With the continuing SARS-CoV-2 pandemic, emergency department (ED) providers will have to be alert and have high suspicion when evaluating a child with a fever and a rash to properly identify children presenting with this serious illness.
Keywords: case report series; fluid-refractory shock; multisystem inflammatory syndrome in children; pediatric covid-19; pediatric fever.
. 2022 Jan 31;14(1):e21764.
doi: 10.7759/cureus.21764. eCollection 2022 Jan.
Challenges in Evaluating Pediatric Fever and Rash in the Era of COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C)
Taylor Jarvill[SUP] 1 [/SUP], Priyanka Lauber[SUP] 1 [/SUP], Samuel Umaru[SUP] 2 [/SUP], Tibisay Villalobos[SUP] 2 [/SUP], Susan K Yaeger[SUP] 1 [/SUP]
Affiliations
- PMID: 35251835
- PMCID: PMC8890603
- DOI: 10.7759/cureus.21764
Abstract
Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged the medical community to characterize and treat a new illness. Now almost two years after the initial confirmed cases of COVID-19, medical teams are faced with another unique disease process temporally related to the pandemic-multisystem inflammatory syndrome in children (MIS-C). The comparison of these patients' presentations illustrates the new challenges of evaluating a pediatric rash and fever in the era of MIS-C.
Case reports: This report presents three cases with features of MIS-C, positivity for SARS-CoV-2, rashes, fevers, gastrointestinal involvement, and elevated inflammatory markers. The first case poses a diagnostic dilemma. While the case 1 patient has many features of MIS-C, his nasal swab was positive for Methicillin-sensitive Staphylococcus Aureus (MSSA). While the second case falls into the case definition of MIS-C, the case 2 patient also met the criteria for atypical Kawasaki disease. Although the third case was positive for SARS-CoV-2, the patient comparatively had a mild elevation of inflammatory markers and a stable clinical course led the treatment team to be more suspicious of immunoglobulin A (IgA) vasculitis versus hand, foot, and mouth disease. The variability in skin rash in patients with MIS-C contributes to the challenge of correctly diagnosing and managing pediatric patients with fever and rash in the emergency department (ED).
Conclusion: Although most children infected with SARS-CoV-2 are asymptomatic or present with mild respiratory illness, it is critical to recognize children at-risk for fluid-refractory shock in MIS-C. With the continuing SARS-CoV-2 pandemic, emergency department (ED) providers will have to be alert and have high suspicion when evaluating a child with a fever and a rash to properly identify children presenting with this serious illness.
Keywords: case report series; fluid-refractory shock; multisystem inflammatory syndrome in children; pediatric covid-19; pediatric fever.