Key result
SARS-CoV-2 hyperinflammatory syndrome causes rapid, fatal decompensation mimicking severe acute COVID-19 and MIS-C.
Why the study?
There is ambiguity and difficulty in distinguishing between acute COVID-19 and MIS-C in pediatric patients with SARS-CoV-2 infection, complicating diagnosis and treatment.
Case Report (n=1)
No
Rapid decompensation in adolescent COVID-19 warrants clinical vigilance; leaves open reliable distinction from MIS-C.
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), an entity in children initially characterized by milder case presentations and better prognoses as compared with adults. Recent reports, however, raise concern for a new hyperinflammatory entity in a subset of pediatric COVID-19 patients. METHODS: We report a fatal case of confirmed COVID-19 with hyperinflammatory features concerning for both multi-inflammatory syndrome in children (MIS-C) and primary COVID-19. RESULTS: This case highlights the ambiguity in distinguishing between these two entities in a subset of pediatric patients with COVID-19-related disease and the rapid decompensation these patients may experience. CONCLUSIONS: Appropriate clinical suspicion is necessary for both acute disease and MIS-C. SARS-CoV-2 serologic tests obtained early in the diagnostic process may help to narrow down the differential but does not distinguish between acute COVID-19 and MIS-C. Better understanding of the hyperinflammatory changes associated with MIS-C and acute COVID-19 in children will help delineate the roles for therapies, particularly if there is a hybrid phenotype occurring in adolescents.
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Beaudry et al. (2020) conducted a case report in COVID-19 / Multi-inflammatory syndrome in children (MIS-C) (n=1). SARS-CoV-2 infection was evaluated. A 15-year-old female rapidly died from a SARS-CoV-2 associated hyperinflammatory syndrome, highlighting the difficulty in differentiating acute COVID-19 from MIS-C and the potential for rapid fatal decompensation.
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