Key result
Typhoid fever misdiagnosed as MIS-C leads to prolonged unnecessary immunosuppressive and antibiotic therapy.
Why the study?
MIS-C is a rare complication of SARS-CoV-2 infection with nonspecific symptoms overlapping common pediatric infections like typhoid fever, leading to potential overdiagnosis and overlooked endemic diseases.
Case Report (n=1)
Clinicians in typhoid-endemic areas should exclude infection before MIS-C immunosuppression; case report leaves open protocol refinements.
We report a case of a 3 year-old boy with possible typhoid fever with recent travel to a typhoid endemic area who was primarily managed as a case of multisystem inflammatory syndrome in children (MIS-C). The patient was initially treated for tonsillitis after a 3 day history of persistent fever, sore throat, and constipation. The patient presented later when he deteriorated. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) viral RNA was not detected but the antibodies were positive. The patient went on to develop mucosal, cardiac, and gastrointestinal manifestations and was subsequently treated with immunoglobulins and corticosteroids for MIS-C. Despite the rarity of MIS-C as a complication of COVID-19 infection, the endemic typhoid fever which is relatively more common was not ruled out. The patient additionally received antibiotics for a total of 5 weeks given his unremitting fever. Even during the COVID-19 pandemic, healthcare professionals should carry out timely testing to exclude more probable differential diagnoses, with area-specific common diseases given due diligence.
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Lasheen et al. (2022) conducted a case report in Multisystem inflammatory syndrome in children (MIS-C) / Typhoid fever (n=1). Treatment for MIS-C (IVIG and corticosteroids) and broad-spectrum antibiotics was evaluated. A 3-year-old boy in a typhoid-endemic area was subjected to a 5-week course of broad-spectrum antibiotics and immunosuppressants for suspected MIS-C without adequately ruling out typhoid fever.
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