1 - Pediatria, Área de Pediatria Médica, Hospital Dona Estefania, Centro Hospitalar Universitário de Lisboa Central, Lisboa
2 - Unidade de Infecciologia Pediátrica, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisboa
- e-poster viewing apresentado numa reunião internacional
Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe but rare complication of coronavirus disease 2019 (COVID-19). It has various clinical features, mainly fever and a rash, as well as cervical involvement.
Case Presentation Summary: A 13-year-old white boy, presented with a 5-day history of high fever, vomiting and anterior neck pain with edema, erythema and an enlarged (3cm), tender left anterior cervical lump. He referred a cervical sunburn the previous week when surfing. Workup revealed normal leucocyte count, increased C-reactive-protein (119,3 mg/L). Cervical US showed multiple bilateral mainly left posterior adenopathies with no retropharyngeal involvement on CT. He was admitted on intravenous amoxicillin plus clavulanic acid and clindamycin for presumed cervical adenophlegmon. At day 5 of antibiotics fever persisted, bilateral conjunctival hyperemia was noted, neck erythema progressed to generalized macular exanthema and he became ill-appearing and hypotensive. Subsequent workups excluded cervical complications and showed hepatosplenomegaly (US), cardiac involvement (troponin I 19,3pg/mL, NT-proBNP 3.357pg/mL), elevated inflammatory biomarkers (sedimentation velocity 38mm/h, ferritin 777 ng/mL, procalcitonin 2,6 ng/mL and D-dimers 3.825 ug/L), with negative blood cultures. Taking into account he was diagnosed with COVID-19 8 weeks before, MIS-C was considered. He was treated with IV immunoglobulin (1g/kg/day 2 days) with complete resolution of fever after 1 day and improvement of inflammatory parameters and was discharged 2 days later.
Learning Points/Discussion: MIS-C may initially present with localized cervical symptoms. This case highlights the need to maintain MIS-C in our differential diagnosis when managing ill-appearing children with presumed cervical infection and a history of recent COVID-19 exposure or infection, that does not respond to antimicrobial therapy.
Palavras Chave: Cervical adenophlegmon; Covid-19; MIS-C.