Case Reports in Pediatrics / 2020 / Article / Tab 3

Case Report

Varying Presentations of Multisystem Inflammatory Syndrome Temporarily Associated with COVID-19

Table 3

Comparing clinical signs and symptoms, lab and imaging, and treatment and outcome for two cases of MIS-C.

Case 1Case 2

Characteristics
GenderMaleFemale
Age (years)1514
1stadmission2ndadmission
Weight (kg)606750
BMI (kg/m2)19.5921.8834.72

Signs and symptoms
FeverYesNoYes
Cough, dyspneaYesYesYes
Sore throatNoNoYes
Decreased appetiteNoYesYes
Nausea, vomitingNoNoNo
DiarrhoeaNoNoYes
FatigueYesYesYes
HeadacheYesNoYes
RashYesNoYes
Desaturation <92%NoYesYes
EdemaNoYesYes

PICU referral
Reason of referralNo PICU referralRespiratory deteriorationRespiratory distress and excessive edema with early signs of shock
Organ supportNoneNIVOxygen therapy through nasal cannula
Pharmacological treatmentNoneVasopressins, antibiotics, diuretics, morphinAntibiotics, antipyretics, diuretics, intravenous immunoglobulins
LOS in hospital102823
LOS in PICU0710

Imaging result
Chest X-rayNormalBilateral consolidationsConsolidation left upper lobe
Chest CTNoBilateral consolidationsPericarditis and bilateral consolidations
Heart ultrasoundNo(i) Dilated left ventricle, ejection fraction 30–35%.
(ii) Diastolic dysfunction grade 1
(iii) Normal right ventricle
(iv) Dilated left atrium
(v) MI 2/4, TI 1/4, dilated truncus pulmonalis
(vi) Pericardial effusion (5 mm), no hemodynamical consequences
(i) Pericarditis with pericardial effusion 15 mm, no hemodynamical consequences
ECGNormalNegative T-waves in the anterior wall with prolonged QT-segment (534 ms)Peripheral low voltages with flattened T-waves in left precordials

Lab results(i) Lymphopenia (929/mm³)
(ii) Thrombocytopenia (116.000/mm³)
(iii) CRP 30 mg/L (maximum)
(iv) Albumin 31 g/L
(v) Normal hepatic enzymes
(i) No lymphopenia/leukopenia
(ii) No thrombocytopenia or thrombocytosis
(iii) Anemia: hemoglobin 7.3 g/dL
(iv) CRP 56.6 mg/L
(v) Albumin 26 g/L
(vi) Normal hepatic enzymes
(vii) Cardiac enzymes:
 (a) NT-proBNP 155919.0 ng/L
 (b) Cardiac troponin T 0.314 µg/L
(viii) D-dimer 6943 ng/ml
(ix) Fibrinogen 482 mg/dL
(i) Lymphopenia (267/mm³)
(ii) Thrombocytosis (808.000/mm³)
(iii) Hemoglobin 7.6 g/dL
(iv) CRP 304.3 mg/L (maximum)
(v) Albumin 24 g/L
(vi) Cardiac enzymes:
 (a) NT-proBNP 3228.0 ng/L
 (b) Cardiac troponin 0.01 mcg/L
(vii) D-dimer 3584 ng/ml
(viii) Fibrinogen 322 mg/dL

Microbiology results(i) Nasopharyngeal swab: PCR SARS-CoV-2 positive(i) Nasopharyngeal swab: PCR SARS-CoV-2 negative
(ii) Heart biopsy: PCR SARS-CoV-2 negative
(iii) SARS-CoV-2 IgG ELISA positive (54.30 AE/mL)
(i) Nasopharyngeal swab: PCR SARS-CoV-2 negative (twice)
(ii) SARS-CoV-2 IgG ELISA positive (41.30 AE/mL)