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.
【저자키워드】 multisystem inflammatory syndrome in children, pediatric COVID-19, pediatric fever, fluid-refractory shock, case report series, 【초록키워드】 COVID-19, Treatment, SARS-CoV-2, coronavirus, SARS-CoV-2 pandemic, pediatric, children, diagnostic, inflammatory markers, MIS-C, Shock, Clinical course, Asymptomatic, IgA, Kawasaki disease, Fever, Patient, Community, Mild, Vasculitis, Inflammatory marker, nasal swab, immunoglobulin A, disease, Critical, Rash, Inflammatory, Atypical, Staphylococcus, criteria, confirmed case, acute respiratory syndrome, Pediatric patient, Variability, syndrome, fevers, treat, skin rash, diagnosing, positive, while, feature, rashes, initial, gastrointestinal involvement, identify, the patient, elevated, contribute, unique, recognize, presenting, mild respiratory, infected with SARS-CoV-2, 【제목키워드】 COVID-19, MIS-C, challenge, Evaluating,