A Young Adolescent With a Multisystem Inflammatory Syndrome in Children (MIS-C)-Like Illness During the COVID-19 Pandemic

A Case Report

Jomol Rajesh, BSc; Poonam Joshi, PhD, MSc; Suman Dabas, MSc; Vanita Kumari, MSc; Rakesh Lodha, MD


Pediatr Nurs. 2022;48(1):47-48. 

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Case Study Answers

Possibility of MIS-C was considered because of age (less than 21 years), fever for three days, hypotension in ICU (107/88 mmHg with warm extremities), raised Trop-T, BNP, Ferritin, PCT, CRP, d-Dimer, Fibrinogen, and normal complement C3 (192 mg/dL and C4 (25 mg/dL) values (CDC, 2020). There is a need to assess the child as a whole clinically rather than just looking at the raised inflammatory markers for the MIS-C criteria put forth by the CDC. One should avoid over-investigating and over-treating children for MIS-C based on the index of suspicion. Because of ECG changes and raised C3 levels, one should look for more common illnesses, such as simple viral fever, septic arthritis, Kawasaki disease, and acute rheumatic fever in children rather than investigating for a rare condition like MIS-C. The child responded well to the prednisolone therapy. Due to initially raised inflammatory markers, such as CRP and ESR, followed by low antibodies' titer and moderately increased troponin, BNP, ferritin, and PCT levels, the child required some investigations for the differential diagnoses. At the time of writing this case study, the child was still under investigation but was successfully stabilized.