Abstract
Clinical and laboratory parameters of multisystem inflammatory syndrome in children (MIS-C) mimic Kawasaki disease (KD). KD has been described in association with dengue, scrub typhus and leptospirosis. However, MIS-C with concomitant infection has rarely been reported in literature. A 14-year-old-girl presented with fever and rash with history of redness of eyes, lips and tongue. Investigations showed anemia, lymphopenia, thrombocytosis with elevated erythrocyte sedimentation rate, C-reactive protein, pro-brain natriuretic peptide, Interleukin-6, ferritin and d-dimer. Scrub typhus immunoglobulin M was positive. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) level was also elevated. A diagnosis of MIS-C with concomitant scrub typhus was proffered. Child received azithromycin, intravenous immunoglobulin and methylprednisolone. After an afebrile period of 2.5 days, child developed unremitting fever and rash. Repeat investigations showed anemia, worsening lymphopenia, thrombocytopenia, transaminitis, hypertriglyceridemia, hyperferritinemia and hypofibrinogenemia which were consistent with a diagnosis of macrophage activation syndrome (MAS). KD, MIS-C and MAS represent three distinct phenotypes of hyperinflammation seen in children during coronavirus disease pandemic. Several tropical infections may mimic or coexist with MIS-C which can be a diagnostic challenge for the treating physician. Identification of coexistence or differentiation between the two conditions is important in countries with high incidence of tropical infections to guide appropriate investigations and treatment.
Keywords: COVID-19; Kawasaki disease; MIS-C; Macrophage activation syndrome; PIMS; Scrub typhus.
【저자키워드】 COVID-19, MIS-C, Kawasaki disease, macrophage activation syndrome, PIMS, scrub typhus, 【초록키워드】 Methylprednisolone, Treatment, coronavirus disease, severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, IgG, Macrophage, Anemia, Intravenous immunoglobulin, coronavirus, pandemic, Azithromycin, children, Infection, diagnostic, interleukin-6, peptide, Diagnosis, C-reactive protein, D-dimer, ferritin, severe acute respiratory syndrome Coronavirus, MIS-C, lymphopenia, Immunoglobulin G, interleukin, Immunoglobulin, Dengue, clinical, hyperinflammation, Child, Kawasaki disease, Fever, phenotype, macrophage activation syndrome, thrombocytopenia, incidence, respiratory, differentiation, Rash, tongue, PIMS, association, Hyperferritinemia, investigation, Inflammatory, Repeat, identification, immunoglobulin M, erythrocyte sedimentation, scrub typhus, hypertriglyceridemia, LIPS, erythrocyte sedimentation rate, acute respiratory syndrome, Activation, sedimentation rate, acute respiratory syndrome coronavirus, worsening, syndrome, dimer, transaminitis, clinical and laboratory parameters, eyes, positive, Hypofibrinogenemia, leptospirosis, typhus, Thrombocytosis, tropical, afebrile, country, laboratory parameter, redness, concomitant infection, described, reported, elevated, condition, 【제목키워드】 Macrophage,