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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
You are seeing a 3yo child whose parents are essential workers and have recently tested positive for COVID-19. The child has had 3 days of fever, vomiting and diarrhea a few times per day with intermittent mild abdominal pain, and has a nonspecific blanching macular rash on the trunk and somewhat on the extremities. The child is well-appearing with good perfusion and hemodynamically stable, but is febrile in the ED. There are no respiratory symptoms, distress, nor hypoxia.
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June 14, 2020 at 12:37 am
Multisystem inflammatory syndrome in children (MIS-C) is a rare complication of COVID-19 that resembles Kawasaki disease. Unlike KD, however, it appears to affect older children and teens, and children of African descent more often. Symptoms include persistent fever, GI symptoms (vomiting, diarrhea, abdominal pain), rashes, headache, lethargy, conjunctivitis, mucous membrane changes, respiratory symptoms, sore throat, and less commonly, swollen hands and feet. Some patients have presented in shock. Common lab abnormalities include lymphocytopenia, neutrophilia, markedly elevated inflammatory markers such as CRP, ESR, procalcitonin, D-dimer, fibrinogen, ferritin, and IL-6; evidence of cardiac effects with elevated troponin and BNP; and hypoalbuminemia, mild transaminitis, elevated LDH, and hypertriglyceridemia. Most affected children initially test negative for COVID-19 by PCR, but later manifest positive serology. Case definitions and clinical guidelines are evolving. CHOP has developed a MIS-C clinical pathway https://www.chop.edu/clinical-pathway/multisystem-inflammatory-syndrome-mis-c-clinical-pathway as have other children’s hospitals.