A Case of Multisystem Inflammatory Syndrome in Children Presenting as Acute Appendicitis and Pancreatitis

Abstract Multisystem Inflammatory Syndrome in Children (MIS-C) is characterized by an inflammation with fever, elevated inflammatory markers, conjunctivitis, rash, impaired coagulation, gastrointestinal symptoms and cardiac abnormalities that may progress to multiorgan failure. The presence of a positive COVID-19 antigen via a PCR test, serological testing for antibodies or close contact with a person diagnosed with COVID-19 helps differentiate MIS-C from other diseases. Gastrointestinal symptoms are recognized to be associated with COVID-19 infection or MIS-C in children, presenting as abdominal pain, gastrointestinal infection with watery stools, appendicitis, ileitis, pancreatitis and hepatitis, confusing the diagnosis with other gastrointestinal diseases. In this case report, we describe an 11 year old boy with MIS-C, who presents acute phlegmona of the appendix for which he undergoes appendectomy, accompanied with acute pancreatitis. These manifestations of MIS-C in our patient resolved without additional complications after a 2 month follow up. We call attention to MIS-C presenting in pediatric patients with fever and abdominal pain which might be caused by appendicitis and pancreatitis, and we recommend abdominal imaging and additional laboratory investigation to promote earlier diagnosis.

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Gluten and Functional Abdominal Pain Disorders in Children

Nutrients ◽

10.3390/nu10101491 ◽

2018 ◽

Vol 10 (10) ◽

pp. 1491 ◽

Cited By ~ 2

Author(s):

Alejandro Llanos-Chea ◽

Alessio Fasano

Keyword(s):

Abdominal Pain ◽

Pediatric Patients ◽

Functional Gastrointestinal Disorders ◽

Gastrointestinal Symptoms ◽

Gluten Sensitivity ◽

Gluten Free ◽

Functional Abdominal Pain ◽

Adults And Children ◽

Small Intestinal ◽

Irritable Bowel

In children, functional gastrointestinal disorders (FGIDs) are common at all ages. Consumption of certain foods, particularly gluten, is frequently associated with the development and persistence of FGIDs and functional abdominal pain disorders (FAPDs) in adults and children. However, this association is not well defined. Even without a diagnosis of celiac disease (CD), some people avoid gluten or wheat in their diet since it has been shown to trigger mostly gastrointestinal symptoms in certain individuals, especially in children. The incidence of conditions such as non-celiac gluten sensitivity (NCGS) is increasing, particularly in children. On the other hand, CD is a chronic, autoimmune small intestinal enteropathy with symptoms that can sometimes be mimicked by FAPD. It is still unclear if pediatric patients with irritable bowel syndrome (IBS) are more likely to have CD. Abdominal, pain-associated FGID in children with CD does not seem to improve on a gluten-free diet. The threshold for gluten tolerance in patients with NCGS is unknown and varies among subjects. Thus, it is challenging to clearly distinguish between gluten exclusion and improvement of symptoms related solely to functional disorders.

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Cardiac Findings in Pediatric Patients With Multisystem Inflammatory Syndrome in Children Associated With COVID-19

Clinical Pediatrics ◽

10.1177/0009922820961771 ◽

2020 ◽

pp. 000992282096177 ◽

Cited By ~ 2

Author(s):

Prashant K. Minocha ◽

Colin K. L. Phoon ◽

Sourabh Verma ◽

Rakesh K. Singh

Keyword(s):

New York ◽

Pediatric Patients ◽

High Rate ◽

Screening Tests ◽

Cardiac Complications ◽

Study Cohort ◽

Large Hospital ◽

Inflammatory Syndrome ◽

Cardiac Testing

Background The overall severity of cardiac disease secondary to acute SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) infection in children appears to be much lower when compared with adults. However, the newly described multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been associated with cardiac complications. Methods We reviewed the clinical course and cardiac testing results in pediatric patients hospitalized with MIS-C at 2 large hospital systems in the New York City metropolitan area over a 3-month period. Results Of the 33 patients (median age 2.8 years) in the study cohort, 24 (73%) had at least one abnormality in cardiac testing: abnormal electrocardiogram (48%), elevated brain natriuretic peptide (43%), abnormal echocardiogram (30%), and/or elevated troponin (21%). Electrocardiogram and echocardiogram abnormalities all resolved by the 2-week outpatient follow-up cardiology visit. Conclusion While 73% of pediatric patients with MIS-C had evidence of abnormal cardiac testing on hospital admission in our study, all cardiac testing was normal by outpatient hospital discharge follow-up. Cardiac screening tests should be performed in all patients diagnosed with MIS-C given the high rate of abnormal cardiac findings in our study cohort.

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New viral hepatitis caused by covid-19 virus- A case report

IP International Journal of Medical Paediatrics and Oncology ◽

10.18231/j.ijmpo.2021.019 ◽

2021 ◽

Vol 7 (2) ◽

pp. 98-102

Author(s):

R H Gobbur ◽

Ranjima M ◽

Aravind S Akki

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Respiratory Failure ◽

Liver Injury ◽

Viral Hepatitis ◽

Pediatric Patients ◽

Acute Abdominal Pain ◽

Diffuse Alveolar Damage ◽

Gastrointestinal Symptoms ◽

Symptoms And Signs

During the current COVID-19 pandemic, the assessment, and management of patients are challenging. The clinical features of COVID-19 are heterogeneous and subtle in many cases. Although diffuse alveolar damage and acute respiratory failure are the main features of COVID-19, the impairment of other organs are also seen. Gastrointestinal symptoms are common in pediatric patients with COVID-19 as SARS-CoV-2 is able to enter gastrointestinal epithelial cells. However, these complaints can also be caused by a COVID-19-independent concomitant abdominal pathology. Therefore, patients with fever with acute abdominal pain, anorexia, nausea, vomiting and diarrhea need to be assessed very thoroughly. Previous studies reported that COVID-19 was likely to result in liver injury. Based on clinical cases, we present our approach of management of children with symptoms and signs of viral hepatitis and concomitant suspicion of COVID-19.

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IL-6 and IL-10 Levels, Rather Than Viral Load and Neutralizing Antibody Titers, Determine the Fate of Patients With Severe Fever With Thrombocytopenia Syndrome Virus Infection in South Korea

Frontiers in Immunology ◽

10.3389/fimmu.2021.711847 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jeong Rae Yoo ◽

Tae-Jin Kim ◽

Sang Taek Heo ◽

Kyung-Ah Hwang ◽

Hyunjoo Oh ◽

...

Keyword(s):

Viral Load ◽

Close Contact ◽

Multiorgan Failure ◽

Severe Disease ◽

Elevated Serum ◽

Gastrointestinal Symptoms ◽

Neutralizing Antibody ◽

Haemaphysalis Longicornis ◽

Antibody Titers ◽

Severe Fever

Severe fever with thrombocytopenia syndrome (SFTS) is a new tick-borne viral disease, and most SFTS virus (SFTSV) infections occur via bites from the tick Haemaphysalis longicornis; however, SFTSV transmission can also occur through close contact with an infected patient. SFTS is characterized by acute high fever, thrombocytopenia, leukopenia, elevated serum hepatic enzyme levels, gastrointestinal symptoms, and multiorgan failure and has a 16.2 to 30% mortality rate. In this study, we found that age, dyspnea rates, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase, multiorgan dysfunction score (MODS), viral load, IL-6 levels, and IL-10 levels were higher in patients with fatal disease than in patients with nonfatal disease during the initial clinical course of SFTS. In addition, we found that IL-6 and IL-10 levels, rather than viral load and neutralizing antibody titers, in patients with an SFTSV infection strongly correlated with outcomes (for severe disease with an ultimate outcome of recovery or death).

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Combined presentation of severe pulmonary COVID-19 and multisystem inflammatory syndrome in children (MIS-C): two reported Egyptian pediatric cases

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-021-00076-w ◽

2021 ◽

Vol 69 (1) ◽

Author(s):

Tarek Hamed ◽

Dina T. Sarhan

Keyword(s):

Critical Illness ◽

Inflammatory Markers ◽

Immune Modulation ◽

Pediatric Patients ◽

Clinical Findings ◽

Case Presentation ◽

Clinical Criteria ◽

Inflammatory Syndrome ◽

Lung Ct

Abstract Background Initial reports from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic described children as being less susceptible to coronavirus disease (COVID-19) than adults. Later on, a severe and novel pediatric disorder termed multisystem inflammatory syndrome in children (MIS-C) emerged. Pediatric patients with SARS-CoV-2 are at risk for critical illness with severe pulmonary COVID-19 and MIS-C. Both are described as two distinct conditions, and the differentiation between them was the scope of many studies. In this report from Egypt, we will describe two unique pediatric cases presented by combined manifestations of severe pulmonary COVID-19 and MIS-C. Case presentation Two patients presented with severe pulmonary COVID-19 evident by pulmonary symptoms, signs, and advanced CO-RADS stage in lung CT were simultaneously fulfilling the clinical criteria of MIS-C including fever, multi-system affection, increased inflammatory markers in addition to the proved COVID-19 by positive serologic tests for SARS-CoV-2 but PCR was negative. Both patients responded well to immune-modulation therapy by IVIG and steroids and discharged well under closed follow-up. Conclusions Although it is debatable to present simultaneously, MIS-C should be considered in patients presenting with typical clinical findings and concerns for pulmonary COVID-19 once the criteria for MIS-C diagnosis is fulfilled. Starting treatment without delay can favor better prognosis.

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Post-Discharge Telephonic Follow-Up of Pediatric Patients Affected by SARS-CoV2 Infection: A Safe and Feasible Way to Monitor Children After Hospitalization. The Experience of a Single Italian Pediatric COVID Center.

10.21203/rs.3.rs-146702/v1 ◽

2021 ◽

Author(s):

Vitangelo Clemente ◽

Costanza Tripiciano ◽

Patrizio Moras ◽

Daniele Deriu ◽

Martina Di Giuseppe ◽

...

Keyword(s):

Pediatric Patients ◽

Social Issues ◽

Pediatric Hospital ◽

Post Discharge ◽

Pharyngeal Swab ◽

Viral Shedding ◽

Discharge From Hospital ◽

Inflammatory Syndrome

Abstract BackgroundSARS-CoV-2 infection in children is often non severe and in the majority of cases does not require long term hospitalization, nevertheless it is burdened with social issues and managing difficulties. To our knowledge there is no literature on telephonic follow up in pediatric patients with positive PCR for SARS-CoV-2 on rhino-pharyngeal swab after discharge. The aim of the study is to describe our experience in a telephonic follow up which can allow early and safe discharge from hospital while keeping the patients under close clinical monitoring.Materials and Methods65 children were admitted for SARS-CoV-2 infection at Bambino Gesù Pediatric Hospital COVID Center from 16th March to 3rd July. We monitored through a telephonic follow-up, using a specific survey, the patients discharged still presenting a positive PCR for SARS-CoV-2. We checked if any symptoms occurred at home until recovery, defined as two consecutive negative PCR for SARS-CoV-2 on rhino-pharyngeal swabs.ResultsDuring the follow up 7 patients had mild and self-limited symptoms related to SARS-CoV-2 infection, while 2 patients were re-hospitalized. 1 patient had Multisystem Inflammatory Syndrome in Children (MIS-C), the other patient had an increase in troponin and D-dimers. We also monitored the average time of viral shedding, resulting in a median duration of 28 days.ConclusionOur experience describes the daily telephonic follow up as safe in pediatric patients discharged with positive PCR. As a matter of fact it could avoid long term hospitalization and allow to promptly re-hospitalize children with major complications such as MIS-C.

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Discontinuation of colchicine therapy in children with Familial Mediterranean Fever

The Journal of Rheumatology ◽

10.3899/jrheum.201158 ◽

2021 ◽

pp. jrheum.201158

Author(s):

Yonatan Butbul Aviel ◽

Silman Rawan ◽

Shafe Fahouma ◽

Isaiah Wexler ◽

Yackov Berkund

Keyword(s):

Abdominal Pain ◽

Familial Mediterranean Fever ◽

Pediatric Patients ◽

Predictors Of Success ◽

Successful Termination ◽

Select Group ◽

Mediterranean Fever ◽

Colchicine Therapy

Objective Colchicine has been considered a life-long therapy for Familial Mediterranean fever (FMF). Recent studies describe patients who discontinued colchicine, but data pertaining to predictors of success were not provided. The aims of our study are to describe a cohort of pediatric patients with FMF who discontinued colchicine therapy, and to identify factors predicting successful termination of colchicine. Methods This study describes a cohort of pediatric patients with FMF who discontinued colchicine therapy following a relatively prolonged attack-free period (≥6 month), and identifies factors predicting successful termination. Data collected included demographic, clinical, and laboratory characteristics of children diagnosed with FMF < 16 years who underwent a trial of colchicine discontinuation. Data from patients who successfully ceased colchicine therapy were compared to that of patients who relapsed. Results Of 571 patients with FMF, 59 (10.3%) discontinued colchicine therapy. The average attack-free period before enrollment was 1.4±0.97 years. Follow-up after ceasing colchicine was 5.0±3.05 years during which time 11 (20%) patients had an attack. The most common symptoms were fever (92%) and abdominal pain (84.6%). For those failing discontinuation, colchicine was restarted within 1.3 years (range: 0.3-5.0; median 0.7 years). A longer attack-free period prior to colchicine discontinuation predicted success. Myalgia and arthritis prior to colchicine cessation were more common among children who required renewal of colchicine. Conclusion Cessation of colchicine therapy should be considered following prolonged remission in a select group of patients. Patients with arthritis or myalgia are more likely to have an attack after ceasing colchicine therapy.

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Cardiac Abnormalities Seen in Pediatric Patients During the SARS‐CoV2 Pandemic: An International Experience

Journal of the American Heart Association ◽

10.1161/jaha.120.018007 ◽

2020 ◽

Vol 9 (21) ◽

Author(s):

Bradley C. Clark ◽

Joan Sanchez‐de‐Toledo ◽

Carles Bautista‐Rodriguez ◽

Nadine Choueiter ◽

Diego Lara ◽

...

Keyword(s):

Pediatric Patients ◽

The United States ◽

Left Ventricular ◽

Medical Community ◽

Healthy Children ◽

Av Block ◽

Coronary Abnormalities ◽

Cardiac Manifestations ◽

Inflammatory Syndrome

Abstract Background During the SARS‐CoV2 pandemic, there has been increase in hyperinflammatory presentation in previously healthy children with a variety of cardiac manifestations. Our objective is to describe the cardiac manifestations found in an international cohort of 55 pediatric cases with multi‐system inflammatory syndrome (MIS‐C) during the SARS‐CoV2 pandemic. Methods and Results We reviewed data on previously healthy pediatric patients (≤18 years) with structurally normal hearts who presented at hospitals in the United States, United Kingdom, Spain and Pakistan with MIS‐C and had consultation with a pediatric cardiologist. Data collected included demographics, clinical presentation, laboratory values, electrocardiographic abnormalities, echocardiographic findings and initial therapies. A total of 55 patients presented with MIS‐C. Thirty‐five patients (64%) had evidence of decreased left ventricular function, 17 (31%) had valvulitis, 12 (22%) with pericardial effusion and 11 (20%) with coronary abnormalities. Twenty‐seven (49%) required ICU admission and 24 (44%) had evidence of shock. Eleven patients (20%) fulfilled complete Kawasaki disease criteria and had lower NT pro‐BNP, D‐dimer and ferritin levels compared with those who did not fulfill criteria. Electrophysiologic abnormalities occurred in 6 patients and included complete atrioventricular (AV) block, transient AV block and ventricular tachycardia. Conclusions We describe the first international cohort of pediatric patients with MIS‐C during the SARS‐CoV2 pandemic with a range of cardiac manifestations. This paper brings awareness and alertness to the global medical community to recognize these children during the pandemic and understand the need for early cardiology evaluation and follow‐up.

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Post-discharge telephonic follow-up of pediatric patients affected by SARS-CoV2 infection in a single Italianpediatric COVID center: a safe and feasible way to monitor children after hospitalization

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01065-w ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Vitangelo Clemente ◽

Costanza Tripiciano ◽

Patrizio Moras ◽

Daniele Deriu ◽

Martina Di Giuseppe ◽

...

Keyword(s):

Pediatric Patients ◽

Social Issues ◽

Pediatric Hospital ◽

Post Discharge ◽

Pharyngeal Swab ◽

Viral Shedding ◽

Discharge From Hospital ◽

Inflammatory Syndrome

Abstract Background SARS-CoV-2 infection in children is often non severe and in the majority of cases does not require long term hospitalization, nevertheless it is burdened with social issues and managing difficulties. To our knowledge there is no literature on telephonic follow up in pediatric patients with positive PCR for SARS-CoV-2 on rhino-pharyngeal swab after discharge. The aim of the study is to describe our experience in a telephonic follow up which can allow early and safe discharge from hospital while keeping the patients under close clinical monitoring. Materials and methods Sixty-five children were admitted for SARS-CoV-2 infection at Bambino Gesù Pediatric Hospital COVID Center from 16th March to 3rd July. We monitored through a telephonic follow-up, using a specific survey, the patients discharged still presenting a positive PCR for SARS-CoV-2. We checked if any symptoms occurred at home until recovery, defined as two consecutive negative PCR for SARS-CoV-2 on rhino-pharyngeal swabs. Results During the follow up 7 patients had mild and self-limited symptoms related to SARS-CoV-2 infection, while 2 patients were re-hospitalized. One patient had Multisystem Inflammatory Syndrome in Children (MIS-C), the other patient had an increase in troponin and D-dimers. We also monitored the average time of viral shedding, resulting in a median duration of 28 days. Conclusion Our experience describes the daily telephonic follow up as safe in pediatric patients discharged with positive PCR. As a matter of fact it could avoid long term hospitalization and allow to promptly re-hospitalize children with major complications such as MIS-C.

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Acute Pancreatitis as a Possible Unusual Manifestation of COVID-19 in Children

Case Reports in Pediatrics ◽

10.1155/2021/6616211 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Niloufar Bineshfar ◽

Alireza Mirahmadi ◽

Fereshteh Karbasian ◽

Elham Pourbakhtyaran ◽

Abdollah Karimi ◽

...

Keyword(s):

Acute Pancreatitis ◽

Pediatric Patients ◽

Gastrointestinal Symptoms ◽

Amylase Level ◽

Rt Pcr ◽

Chain Reaction ◽

Unusual Manifestation ◽

The World ◽

Polymerase Chain ◽

Pcr Test

Coronavirus disease-2019 (COVID-19) which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has spread throughout the world causing problems for millions of people. Symptoms of COVID-19 in pediatric patients include both respiratory and gastrointestinal symptoms. The most common symptoms are fever, cough, and fatigue. In this report, we describe a case of a previously well 14-year-old boy, who presented to our emergency department with a complaint of abdominal pain, nausea, and vomiting without fever or respiratory symptoms. He was diagnosed with acute pancreatitis based on an abnormal amylase level and abdomen computed tomography (CT) and later found to be infected by SARS-CoV-2, by a positive reverse transcriptase-polymerase chain reaction (RT-PCR) test.

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