Article ; Online: Multisystem Inflammatory Syndrome in a Child with Scrub Typhus and Macrophage Activation Syndrome.
Journal of tropical pediatrics
2021 Volume 67, Issue 1
Abstract: Lay summary: Clinical and laboratory parameters of multisystem inflammatory syndrome in children ... which were consistent with a diagnosis of macrophage activation syndrome (MAS). KD, MIS-C and MAS represent ... MIS-C) mimic Kawasaki disease (KD). KD has been described in association with dengue, scrub typhus and ...
| Abstract | Lay summary: Clinical and laboratory parameters of multisystem inflammatory syndrome in children (MIS-C) mimic Kawasaki disease (KD). KD has been described in association with dengue, scrub typhus and leptospirosis. However, MIS-C with concomitant infection has rarely been reported in literature. A 14-year-old-girl presented with fever and rash with history of redness of eyes, lips and tongue. Investigations showed anemia, lymphopenia, thrombocytosis with elevated erythrocyte sedimentation rate, C-reactive protein, pro-brain natriuretic peptide, Interleukin-6, ferritin and d-dimer. Scrub typhus immunoglobulin M was positive. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) level was also elevated. A diagnosis of MIS-C with concomitant scrub typhus was proffered. Child received azithromycin, intravenous immunoglobulin and methylprednisolone. After an afebrile period of 2.5 days, child developed unremitting fever and rash. Repeat investigations showed anemia, worsening lymphopenia, thrombocytopenia, transaminitis, hypertriglyceridemia, hyperferritinemia and hypofibrinogenemia which were consistent with a diagnosis of macrophage activation syndrome (MAS). KD, MIS-C and MAS represent three distinct phenotypes of hyperinflammation seen in children during coronavirus disease pandemic. Several tropical infections may mimic or coexist with MIS-C which can be a diagnostic challenge for the treating physician. Identification of coexistence or differentiation between the two conditions is important in countries with high incidence of tropical infections to guide appropriate investigations and treatment. |
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| MeSH term(s) | Adolescent ; Azithromycin/therapeutic use ; Biomarkers/blood ; COVID-19/blood ; COVID-19/complications ; COVID-19/diagnosis ; COVID-19/therapy ; Child ; Female ; Fever/etiology ; Humans ; Immunoglobulin G/blood ; Immunoglobulins, Intravenous/therapeutic use ; Macrophage Activation Syndrome/complications ; Macrophage Activation Syndrome/diagnosis ; Macrophage Activation Syndrome/drug therapy ; Macrophage Activation Syndrome/immunology ; Methylprednisolone/administration & dosage ; Methylprednisolone/therapeutic use ; Pandemics ; SARS-CoV-2 ; Scrub Typhus/complications ; Scrub Typhus/diagnosis ; Scrub Typhus/drug therapy ; Systemic Inflammatory Response Syndrome/blood ; Systemic Inflammatory Response Syndrome/diagnosis ; Systemic Inflammatory Response Syndrome/drug therapy ; Systemic Inflammatory Response Syndrome/immunology | |||||
| Chemical Substances | Biomarkers ; Immunoglobulin G ; Immunoglobulins, Intravenous ; Azithromycin (83905-01-5) ; Methylprednisolone (X4W7ZR7023) | |||||
| Language | English | |||||
| Publishing date | 2021-03-31 | |||||
| Publishing country | England | |||||
| Document type | Case Reports ; Journal Article | |||||
| ZDB-ID | 800065-7 | |||||
| ISSN | 1465-3664 ; 0449-3281 ; 0142-6338 | |||||
| ISSN (online) | 1465-3664 | |||||
| ISSN | 0449-3281 ; 0142-6338 | |||||
| DOI | 10.1093/tropej/fmab021 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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