Acute Abdomen and Multisystem Inflammatory Syndrome in Children with COVID-19: A Case Report and Review of Pathophysiology, Gastrointestinal Symptoms and Abdominal Radiology

Introduction: Pediatric patients with coronavirus disease 2019 (COVID-19) account for less than 5% of the total incidence. The scientific literature reports that most patients are asymptomatic or present mild symptoms. However, they may only manifest gastrointestinal symptoms and even present an acute abdomen; a severe form of presentation has been reported, called multisystem inflammatory syndrome in children. Case Presentation: We report a 10-year-old girl who presents COVID-19 in the form of an acute abdomen because of severe sigmoiditis who developed multisystem inflammatory syndrome together with shock. The patient fully recovered without sequelae with medical treatment. We provide computed tomography and ultrasound images and review scientific information available on gastrointestinal COVID-19 pathophysiology from the pediatric point of view. Conclusion: A high index of suspicion is needed for diagnosing COVID-19 in the event of any pediatric acute abdomen during the pandemic, and screening should be undertaken even without an epidemiologic setting and in the absence of respiratory symptoms or radiologic chest signs because acute abdomen could be a clinical presentation of MIS-C in children.

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COVID-19 associated multisystem inflammatory syndrome in children mimicking acute appendicitis - how to differentiate and conduct pediatric patients during the pandemic? - Proposal of a management flowchart

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20213012 ◽

2021 ◽

Vol 48 ◽

Author(s):

LORAINE ENTRINGER FALQUETO ◽

CAROLINA MARTINS VISSOCI ◽

ISABELLA CRISTINA BONETTO FERREIRA ◽

AMANDA GINANI ANTUNES ◽

FERNANDO ANTÔNIO BERSANI AMADO ◽

...

Keyword(s):

Acute Appendicitis ◽

Acute Abdomen ◽

Initial Phase ◽

Pediatric Patients ◽

Pediatric Population ◽

Gastrointestinal Symptoms ◽

Signs And Symptoms ◽

Clinical History ◽

Pediatric Hospital ◽

Inflammatory Syndrome

ABSTRACT Introduction: the new coronavirus pandemic has been a reality throughout 2020, and it has brought great challenges. The virus predominantly manifests in the pediatric population with mild symptoms. However, an increase in the incidence of Multisystemic Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 has been described in the literature. MIS-C manifests mainly with fever and gastrointestinal symptoms and may mimic acute abdomen due to acute appendicitis. The objective of this study is to propose a care flowchart for suspected cases of acute appendicitis in the initial phase in pandemic times, considering the possibility of MIS-C. This situation was brought up by a patient treated in a pediatric hospital in Brazil. Discussion: It was possible to identify common signs and symptoms in the reported patient and those published cases that may serve as alerts for early identification of MIS-C cases. Based on the literature review and on the similarities between the syndrome and the inflammatory acute abdomen in children, we elaborated an initial approach for these cases to facilitate the identification, early diagnosis, and management. The flowchart considers details of the clinical history, physical examination, and complementary exams prior to the indication of appendectomy in patients with initial phase symptoms. Conclusion: MIS-C, although rare and of poorly known pathophysiology, is most often severe and has a high mortality risk. The use of the proposed flowchart can help in the diagnosis and early treatment of MIS-C.

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Epidemiological, clinical profile and outcome of multi-system inflammatory syndrome in children (MIS-C) admitted in government tertiary care hospital of Kanyakumari district

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20214163 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1879

Author(s):

Steeve Gnana Samuel ◽

Suresh Placode Monikanta ◽

Arul Prasath Subramoniam Vasudevan ◽

Nagalekshmi Rajamanickam

Keyword(s):

Tertiary Care ◽

Gastrointestinal Symptoms ◽

Signs And Symptoms ◽

Intensive Care Treatment ◽

Care Hospital ◽

Cutaneous Manifestations ◽

Female Ratio ◽

Wide Range ◽

High Index Of Suspicion ◽

Inflammatory Syndrome

We report twelve children with a median age of 7 year (IQR 3years to 12 years) who fulfilled MIS-C WHO criteria. The male to female ratio was 2:1. Affected children had gastrointestinal symptoms (92%), respiratory symptoms (67%), cardiovascular symptoms (58%), neurological symptoms (50%), renal symptoms (33%), followed by muco-cutaneous manifestations (25%). 83% of children had lymphocytopenia. It was found that lymphocytopenia was directly correlated to disease severity. The majority of the children had elevated CRP, transaminase, and deranged coagulation profiles. All 4 systems were involved in 7 children (58%). Intensive care treatment was required for all the cases (100%). There were no deaths. Children with coronavirus disease 2019 (COVID-19) associated MIS-C can present with a wide range of signs and symptoms. They can deteriorate quickly and hence a high index of suspicion; early referral and early initiation of treatment with steroids and IVIg can save the lives of children with MIS-C.

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COVID-19 and Multisystem Inflammatory Syndrome in Latin American children: a multinational study

10.1101/2020.08.29.20184242 ◽

2020 ◽

Author(s):

Omar Yassef Antunez-Montes ◽

Maria Isabel Escamilla ◽

Augusto Flavio Figueroa-Uribe ◽

Erick Arteaga-Menchaca ◽

Manuel Lavariega-Sarachaga ◽

...

Keyword(s):

Latin American ◽

Medical Condition ◽

Severe Disease ◽

Gastrointestinal Symptoms ◽

Pediatric Intensive Care ◽

Severe Form ◽

Current Evidence ◽

Lower Socioeconomic ◽

American Children ◽

Inflammatory Syndrome

Background To date, there are no comprehensive data on pediatric COVID19 from Latin America. This study aims to assess COVID-19 and Multisystem Inflammatory Syndrome (MIS C) in Latin American children, in order to appropriately plan and allocate resources to face the pandemic on a local and International lever Methods Ambispective multicentre cohort study from five Latin American countries. Children aged 18 years or younger with microbiologically confirmed SARS CoV 2 infection were included. Findings 409 children were included, with a median age of 53.0 years (IQR 0.6 9.0). Of these, 95 191 (23.2%) were diagnosed with MIS C. 191 (46.7%) children were admitted to hospital and 52 (12.7%) required admission to a Pediatric Intensive Care Unite (PICU). 92 (22.5%) patients required oxygen support: 8 (2%) were started on continuous positive airway pressure (CPAP) and 29 (7%) on mechanical ventilation. 35 (8.5%) patients required inotropic support. The following factors were associated with PICU admission: pre-existing medical condition (P < 0.0001), immunodeficiency (P = 0.01), lower respiratory tract infection (P< 0.0001), gastrointestinal symptoms (P = 0.006), radiological changes suggestive of pneumonia and acute respiratory distress syndrome (P< 0.0001), low socioeconomic conditions (P 0.009). Conclusions This study shows a generally more severe form of COVID 19 and a high number of MIS C in Latin American children, compared with studies from China, Europe and North America, and support current evidence of a more severe disease in Latin/Hyspanic children or in people of lower socioeconomic level. The findings highlight an urgent need of more data of COVID 19 in South America.

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Coeliac disease presenting atypically: A much wider spectrum

Tropical Doctor ◽

10.1177/0049475521991348 ◽

2021 ◽

pp. 004947552199134

Author(s):

Avinash Lomash ◽

Abhinaya Venkatakrishnan ◽

Meenakshi Bothra ◽

Bhavna Dhingra ◽

Praveen Kumar ◽

...

Keyword(s):

Coeliac Disease ◽

Gestational Age ◽

Dermatitis Herpetiformis ◽

Mode Of Delivery ◽

Gastrointestinal Symptoms ◽

Stunted Growth ◽

Significant Difference ◽

High Index Of Suspicion ◽

Gestational Age At Birth ◽

Age At Birth

Atypical coeliac disease in young children is frequently missed when it presents atypically as non-gastrointestinal presentations to different specialties. There was a greater delay (54 months) in establishing the diagnosis in those with atypical coeliac disease (p < 0.001). No difference was observed in the mode of delivery or duration of breast feeding, but significant difference was observed between gestational age at birth (p < 0.001). Most cases showed stunted growth and underweight. Irritability, anaemia, rickets, dermatitis herpetiformis, alopecia and intussusception were other common predictors of atypical coeliac disease. Because of a myriad spectrum of non-gastrointestinal symptoms, at any age with diverse presentation, a high index of suspicion is therefore required.

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Diversity of Cardiac and Gastrointestinal Presentations of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: A Case Series

Global Pediatric Health ◽

10.1177/2333794x21996613 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2199661

Author(s):

Anuja R. Shikhare ◽

Rimsha M. Iqbal ◽

Rabail Tariq ◽

Daniel R. Turner ◽

Bassam M. Gebara ◽

...

Keyword(s):

Kawasaki Disease ◽

Gastrointestinal Symptoms ◽

Case Series ◽

Asymptomatic Infection ◽

Cardiac Monitoring ◽

Delayed Presentation ◽

Terminal Ileitis ◽

Serologic Evidence ◽

Cardiac Manifestations ◽

Inflammatory Syndrome

COVID-19 is generally a benign or asymptomatic infection in children, but can occasionally be severe or fatal. Delayed presentation of COVID-19 with hyperinflammation and multi-organ involvement was recently recognized, designated the Multisystem Inflammatory Syndrome in Children (MIS-C). Six children with MIS-C with molecular and serologic evidence of SARS-CoV-2 infection were admitted to our hospital between May 5, 2020 and June 25, 2020. All had fever and weakness; 4/6 presented with gastrointestinal symptoms. Two children had features of complete Kawasaki disease, 3 had incomplete Kawasaki disease, while 1 had terminal ileitis with delayed onset of circulatory shock. Treatment consisted of intravenous immunoglobulin and aspirin for Kawasaki-like disease. Remdesivir, corticosteroids, and infliximab were used when indicated. Median hospitalization was 7 days. Immediate treatment resulted in rapid clinical improvement. In children presenting with hyperinflammatory syndromes without cardiac manifestations, testing for SARS-CoV-2 RNA and antibodies, with close cardiac monitoring should be pursued due to the manifold presentations of SARS-CoV-2 infection in children.

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Shared inflammatory pathways and therapeutic strategies in COVID-19 and cancer immunotherapy

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2021-002392 ◽

2021 ◽

Vol 9 (5) ◽

pp. e002392

Author(s):

Lorenzo Iovino ◽

Laurel A Thur ◽

Sacha Gnjatic ◽

Aude Chapuis ◽

Filippo Milano ◽

...

Keyword(s):

Preliminary Evidence ◽

Severe Form ◽

Cell Transplant ◽

T Cell Therapy ◽

Cell Therapies ◽

Novel Drugs ◽

Prospective Trials ◽

Systemic Manifestations ◽

Anti Inflammatory ◽

Inflammatory Syndrome

COVID-19, the syndrome caused by the infection with SARS-CoV-2 coronavirus, is characterized, in its severe form, by interstitial diffuse pneumonitis and acute respiratory distress syndrome (ARDS). ARDS and systemic manifestations of COVID-19 are mainly due to an exaggerated immune response triggered by the viral infection. Cytokine release syndrome (CRS), an inflammatory syndrome characterized by elevated levels of circulating cytokines, and endothelial dysfunction are systemic manifestations of COVID-19. CRS is also an adverse event of immunotherapy (IMTX), the treatment of diseases using drugs, cells, and antibodies to stimulate or suppress the immune system. Graft-versus-host disease complications after an allogeneic stem cell transplant, toxicity after the infusion of chimeric antigen receptor-T cell therapy and monoclonal antibodies can all lead to CRS. It is hypothesized that anti-inflammatory drugs used for treatment of CRS in IMTX may be useful in reducing the mortality in COVID-19, whereas IMTX itself may help in ameliorating effects of SARS-CoV-2 infection. In this paper, we focused on the potential shared mechanisms and differences between COVID-19 and IMTX-related toxicities. We performed a systematic review of the clinical trials testing anti-inflammatory therapies and of the data published from prospective trials. Preliminary evidence suggests there might be a benefit in targeting the cytokines involved in the pathogenesis of COVID-19, especially by inhibiting the interleukin-6 pathway. Many other approaches based on novel drugs and cell therapies are currently under investigation and may lead to a reduction in hospitalization and mortality due to COVID-19.

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Diagnosing gastric volvulus in chest X-ray: report of three cases

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa229 ◽

2020 ◽

Vol 2020 (7) ◽

Author(s):

Narendra Pandit ◽

Abhijeet Kumar ◽

Tek Narayan Yadav ◽

Qamar Alam Irfan ◽

Sujan Gautam ◽

...

Keyword(s):

Computed Tomography ◽

Acute Abdomen ◽

Gastric Volvulus ◽

X Ray ◽

Pain Abdomen ◽

Life Threatening ◽

Chest X Ray ◽

High Index Of Suspicion ◽

Specific Symptoms ◽

Prompt Diagnosis

Abstract Gastric volvulus is a rare abnormal rotation of the stomach along its axis. It is a surgical emergency, hence requires prompt diagnosis and treatment to prevent life-threatening gangrenous changes. Hence, a high index of suspicion is required in any patients presenting with an acute abdomen in emergency. The entity can present acutely with pain abdomen and vomiting, or as chronic with non-specific symptoms. Chest X-ray findings to diagnose it may be overlooked in patients with acute abdomen. Here, we report three patients with gastric volvulus, where the diagnosis was based on the chest X-ray findings, confirmed with computed tomography, and managed successfully with surgery.

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SARS-CoV-2 identification in an acute appendicitis case: Acute abdomen as manifestation of Multisystem Inflammatory Syndrome in a child with COVID-19

The Brazilian Journal of Infectious Diseases ◽

10.1016/j.bjid.2021.101651 ◽

2021 ◽

pp. 101651

Author(s):

Amanda Munhoz Serra ◽

Andréa Maria Cordeiro Ventura ◽

Lucas Freitas Xavier ◽

Angélica Braz Simões ◽

Amaro Nunes Duarte-Neto

Keyword(s):

Acute Appendicitis ◽

Acute Abdomen ◽

Inflammatory Syndrome

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Russia in Greater Mediterranean: New Pacific Eurasian Transition

Vestnik RUDN International Relations ◽

10.22363/2313-0660-2021-21-3-441-458 ◽

2021 ◽

Vol 21 (3) ◽

pp. 441-458

Author(s):

Ivan Alexandrovich Chikharev

Keyword(s):

Political Development ◽

Mediterranean Region ◽

Scientific Information ◽

Point Of View ◽

Special Role ◽

Important Conclusion ◽

Political Transformations ◽

The Pacific ◽

History Of ◽

The Mediterranean

The relevance of the issues raised in the article is related to the active return of Russia to the Mediterranean region, as well as the international political transformations taking place in it. The purpose of the article is to identify the historical foundations, current state and strategic prospects of Russias presence and international influence in the Greater Mediterranean region. The article is based on the methodology of critical geopolitics, historical and comparative approaches, which critically analyze the geopolitical structures of the region, built in the interests of various regional and extra-regional political forces. The historical material of the ancient, medieval, new and modern periods in the history of the macro-region is used, including the poorly studied times of the Mongol presence on the eastern shores of the Mediterranean Sea. Scientific works on the history, geography and international relations in the region, written in the 18th - 19th centuries, as well as modern scientific information on the trends of technological, infrastructural and political development of the Mediterranean region are introduced into scientific circulation. An important element of the article is the thesis about the special role of Russia in the Pacific-European (Eurasian) transit. From the authors point of view, it includes not only the full implementation of Russias transport and logistics potential in the macro-region, but also the transfer of modern technologies, as well as the promotion of the formation of sustainable political regimes. As a result, a conclusion is made about the deep historical foundations of Russias presence and influence in the region, its strategic prospects are justified, and the main directions of our countrys international activities in the Mediterranean region are highlighted. An important conclusion of the article is the thesis about the need for a multilateral balanced approach to solving macro-regional problems.

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Contributo allo studio dell'ereditarietà della S. di Marfan. Descrizione di un albero genealogico di quattro generazioni con un matrimonio fra consanguinei affetti

Acta geneticae medicae et gemellologiae ◽

10.1017/s1120962300018631 ◽

1959 ◽

Vol 8 (4) ◽

pp. 455-482 ◽

Cited By ~ 4

Author(s):

L. Capotorti ◽

R. Gaddini De Benedetti ◽

P. Rizzo

Keyword(s):

Cardiac Involvement ◽

Autosomal Dominant ◽

General Medicine ◽

Severe Form ◽

Point Of View ◽

Sufficient Evidence ◽

Continuous Increase ◽

General Picture ◽

Ectopia Lentis ◽

Skeletal Malformations

SUMMARYThe AA. have studied the pedigree of a family with Marfan's Syndrome (M.S.) including 90 persons of four generations. 37 subjects were examined both from a general and from an ophcalmological point of view. Furthermore reliable informations have been obtained about 13 more subjects related with them. Out of the total of 50 persons about whom the A A. have gathered sufficient evidence, 22 turned out to be affected by « ectopia lentis », 20 by various skeletal malformations, all of them included in the general picture of M.S. In 5 more cases some signs of cardiac involvement have been found. The percentage of affected subjects in the whole family was 40%, whereas the hereditary transmission of this syndrome appeared to be typical of a presumably single autosomal dominant character.This is the first report in the literature of a consanguineous marriage between two subjects both affected by M.S. Out of 9 children who were born from this couple, 4 presented the M.S. (2 of them in a particularly severe form), 3 died during infancy, one was a stillborn and only one was a healthy individual.The number of cases of this syndrome described in the medical literature is in continuous increase. Furthermore the growing prominence it is assuming in general medicine, owing to the skeletal, cardiac and vascular anomalies, stimulates to a more thorough knowledge of its hereditary transmission, in the hope of achieving a useful social prophylaxis.

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