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A Case of COVID-19 Mimicking Acute Appendicitis in Multi-System Inflammatory Syndrome.
Cureus. 2021 Jun; 13(6):e15600.C

Abstract

Children's naive immune systems allow for a unique course of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus when compared to adults. In multi-system inflammatory syndrome in children (MIS-C), a current or recent SARS-CoV-2 infection can cause fever and elevated inflammatory markers in individuals under the age of 21. Similar to Kawasaki disease, Kikuchi disease, systemic lupus erythematosus, toxic shock syndrome (TSS), and macrophage activation syndrome (MAS), there is an influx of inflammation associated with MIS-C that creates this pathologic state. Because MIS-C affects numerous organ systems, its presentation varies substantially, thus making it difficult to diagnose and treat in a timely fashion. In our case, a previously healthy four-year-old African American female initially presented to the emergency department (ED) with high fever, abdominal pain, and headache after recent SARS-Co-V-2 exposure. After initially being diagnosed with a urinary tract infection (UTI), she returned with a myriad of symptoms, including persistent fever, abdominal pain, and conjunctivitis. Her initial SARS-CoV-2 test returned positive, and she was admitted and placed on broad-spectrum antibiotics then requiring vasopressors, mechanical ventilation, and an appendectomy. Her workup revealed elevated inflammatory markers, elevated brain natriuretic peptide (BNP), anemia, thrombocytopenia, pyuria, and hypercoagulability meeting the criteria for MIS-C. In addition to antibiotics, her treatment included IV immunoglobulin and methylprednisolone until the patient was stabilized for discharge. As more is learned about SARS-CoV-2, it will become increasingly important to consider the development and implications of MIS-C. Educating providers on the wide range of MIS-C presentations can lead to more effective preventative measures and treatments.

Authors+Show Affiliations

College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine (LECOM) - Bradenton, Bradenton, USA.College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine (LECOM) - Bradenton, Bradenton, USA.Clinical Curriculum Integration & Assessment, Lake Erie College of Osteopathic Medicine (LECOM) - Bradenton, Bradenton, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

34277221

Citation

Martin, Anna, et al. "A Case of COVID-19 Mimicking Acute Appendicitis in Multi-System Inflammatory Syndrome." Cureus, vol. 13, no. 6, 2021, pp. e15600.
Martin A, Otto T, Smith T. A Case of COVID-19 Mimicking Acute Appendicitis in Multi-System Inflammatory Syndrome. Cureus. 2021;13(6):e15600.
Martin, A., Otto, T., & Smith, T. (2021). A Case of COVID-19 Mimicking Acute Appendicitis in Multi-System Inflammatory Syndrome. Cureus, 13(6), e15600. https://doi.org/10.7759/cureus.15600
Martin A, Otto T, Smith T. A Case of COVID-19 Mimicking Acute Appendicitis in Multi-System Inflammatory Syndrome. Cureus. 2021;13(6):e15600. PubMed PMID: 34277221.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Case of COVID-19 Mimicking Acute Appendicitis in Multi-System Inflammatory Syndrome. AU - Martin,Anna, AU - Otto,Taylor, AU - Smith,Travis, Y1 - 2021/06/11/ PY - 2021/06/10/accepted PY - 2021/7/19/entrez PY - 2021/7/20/pubmed PY - 2021/7/20/medline KW - covid-19 KW - multi-system inflammatory syndrome in children (mis-c) KW - sars-cov-2 SP - e15600 EP - e15600 JF - Cureus JO - Cureus VL - 13 IS - 6 N2 - Children's naive immune systems allow for a unique course of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus when compared to adults. In multi-system inflammatory syndrome in children (MIS-C), a current or recent SARS-CoV-2 infection can cause fever and elevated inflammatory markers in individuals under the age of 21. Similar to Kawasaki disease, Kikuchi disease, systemic lupus erythematosus, toxic shock syndrome (TSS), and macrophage activation syndrome (MAS), there is an influx of inflammation associated with MIS-C that creates this pathologic state. Because MIS-C affects numerous organ systems, its presentation varies substantially, thus making it difficult to diagnose and treat in a timely fashion. In our case, a previously healthy four-year-old African American female initially presented to the emergency department (ED) with high fever, abdominal pain, and headache after recent SARS-Co-V-2 exposure. After initially being diagnosed with a urinary tract infection (UTI), she returned with a myriad of symptoms, including persistent fever, abdominal pain, and conjunctivitis. Her initial SARS-CoV-2 test returned positive, and she was admitted and placed on broad-spectrum antibiotics then requiring vasopressors, mechanical ventilation, and an appendectomy. Her workup revealed elevated inflammatory markers, elevated brain natriuretic peptide (BNP), anemia, thrombocytopenia, pyuria, and hypercoagulability meeting the criteria for MIS-C. In addition to antibiotics, her treatment included IV immunoglobulin and methylprednisolone until the patient was stabilized for discharge. As more is learned about SARS-CoV-2, it will become increasingly important to consider the development and implications of MIS-C. Educating providers on the wide range of MIS-C presentations can lead to more effective preventative measures and treatments. SN - 2168-8184 UR - https://www.unboundmedicine.com/medline/citation/34277221/A_Case_of_COVID-19_Mimicking_Acute_Appendicitis_in_Multi-System_Inflammatory_Syndrome. L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/34277221/ DB - PRIME DP - Unbound Medicine ER -
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