Spectrum of Post Covid-19 Manifestations in Children: A Case Series

Document Type : case report

Authors

1 Department of Paediatrics, Topiwala National Medical College and B.Y.L Nair Hospital, Mumbai, 400008, India.

2 Adichunchanagiri Institute of Medical Sciences, B G Nagara, Mandya, 571448, Karnataka, India.

Abstract

Background: Multisystem Inflammatory syndrome in Children (MIS-C) is a common diagnosis among children in the post Covid-19 era, which usually presents with fever and varied systemic manifestations. BCG vaccination site reaction as a manifestation of MIS-C is barely ever documented. In this series, we present a rare such case report along with the other six other cases.
Case presentations: Seven cases with MIS-C are presented with four male and three female children. The median age of presentation was 3 (range: 0.4-14) years. Fever was the most common (100%) symptom followed by muco-cutaneous manifestation (50%, 4/7), as well as gastrointestinal (37.5%, 3/7), and cardiovascular symptoms (37.5%, 3/7). The clinical features which led to the diagnosis include BCG site vaccination, erythema multiforme, periungual and perineal peeling, unilateral knee joint effusion, skin scalding syndrome, urticaria, and acute glomerulonephritis. The initial work-up for fever did not yield any cause, except for a non-specific elevation of inflammatory markers. 6 cases had elevated anti-SARS-Co-V2 antibody titres with a negative RTPCR/RAT test and 1 case yielded positive RTPCR for covid status for acute infection. 2D Echocardiography showed Coronary artery dilatation in two patients which resolved on follow-up. All the patients responded well to intravenous immunoglobulin and methylprednisolone combination therapy with antiplatelet drugs.
Conclusion: BCG vaccination site reaction could occur due to antigen-homology. Cardiovascular manifestations (coronary artery dilatation) without hemodynamic instability may also be a manifestation of MIS-C, thereby placing 2D-Echo as an important step in diagnostic workup.  

Keywords

References

  1. Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MB, et al. Multisystem inflammatory syndrome in US children and adolescents. New England Journal of Medicine. 2020 Jul 23;383(4):334-46.
  2. World Health Organization. WHO. WHO Coronavirus disease (COVID-19) dashboard [Internet]. Geneva: World Health Organization; 2020 [cited 2020 Jun 22] [Internet].
  3. Selva KJ, Van De Sandt CE, Lemke MM, Lee CY, Shoffner SK, Chua BY, et al. Systems serology detects functionally distinct coronavirus antibody features in children and elderly. Nature communications. 2021 Apr 1;12(1):2037.
  4. Howard‐Jones AR, Burgner DP, Crawford NW, Goeman E, Gray PE, Hsu P, et al. COVID‐19 in children. II: Pathogenesis, disease spectrum and management. Journal of paediatrics and child health. 2022 Jan;58(1):46-53.
  5. Feldstein LR, Tenforde MW, Friedman KG, Newhams M, Rose EB, Dapul H, et al. Characteristics and outcomes of US children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19. Jama. 2021 Mar 16;325(11):1074-87.
  6. Sachdeva M, Agarwal A, Sra HK, Rana M, Pradhan P, Singh M, et al. Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C): A systematic review of studies from India. Indian Pediatrics. 2022 Jul;59(7):563-9.
  7. Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K, et al. Multisystem inflammatory syndrome in children: a systematic review. EClinicalMedicine. 2020 Sep 1;26.
  8. Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, et al. Multisystem inflammatory syndrome in children in New York State. New England Journal of Medicine. 2020 Jul 23;383(4):347-58.
  9. Rowley AH. Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children. Nature Reviews Immunology. 2020 Aug;20(8):453-4.
  10. Valverde I, Singh Y, Sanchez-de-Toledo J, Theocharis P, Chikermane A, Di Filippo S, et al. Acute cardiovascular manifestations in 286 children with multisystem inflammatory syndrome associated with COVID-19 infection in Europe. Circulation. 2021 Jan 5;143(1):21-32.
  11. Naka F, Melnick L, Gorelik M, Morel KD. A dermatologic perspective on multisystem inflammatory syndrome in children. Clinics in dermatology. 2021 Jan 1;39(1):163-8.
  12. Thadchanamoorthy V, Dayasiri K. Refractory Kawasaki Disease Presenting With Erythema at Bacille Calmette-Guérin Inoculation Site: A Paediatric Case Report. Cureus. 2020 Oct;12(10).
  13. Tsuboya N, Makino H, Mitani Y, Ito M, Ohya K, Morimoto M, et al. Erythema and induration of Bacillus Calmette-Guérin scar associated with multisystem inflammatory syndrome in children in Japan: a case report. Frontiers in Pediatrics. 2022 Mar 11;10:849473.
  14. Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, Abrams J, et al. COVID-19–associated multisystem inflammatory syndrome in children United States, March–July 2020. Morbidity and mortality weekly report. 2020 Aug 8; 69(32):1074.
  15. Wang Z, Zhao S, Tang Y, Wang Z, Shi Q, Dang X, et al. Potentially effective drugs for the treatment of COVID-19 or MIS-C in children: a systematic review. European journal of pediatrics. 2022 May;181(5):2135-46.
Journal of Pediatric Perspectives
Volume 12, Issue 6
June 2024
Pages 18877-18886

Files

Share

How to cite

Statistics