(614) A Toddler With Chronic Renal Disease in Shock: A MIS-C Case Report

Introduction: Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare but serious condition associated with COVID-19. It presents 2 - 8 weeks after confirmed SARS-Cov-2 infection, causing inflammation and compromise of multiple organs. Severe illness presents with fever and multisystemic organ dysfunction. Shock, cardiovascular, gastrointestinal, and hematologic manifestations prevail over respiratory and neurological symptoms. Patients diagnosed with MIS-C are usually 6 to 12 years old, reports of MIS-C are challenging and limited.

Description: A 1 year 10 months old male with left renal agenesis, right solitary kidney, VUR grade 5, CKD on peritoneal dialysis and g-tube who presented to ED due to high fevers, hypoactivity, irritability, vomiting and diarrhea for 4 days. Patient admitted with a working diagnosis of viral infection. After 3 days of treatment, the patient did not improve and was transferred to PICU with a diagnosis of sepsis due to toxic appearance, signs of hemodynamic instability and respiratory distress. Patient received fluid resuscitation and broad-spectrum IV antibiotics without improvement, all cultures resulted negative. Therapy was escalated to inotropes and mechanical ventilation due to patient’s instability. In view of clinical scenario, while management for septic shock, and a recent history of SARS-COV2 infection, along with his multiorgan failure without expected improvement, an assessment was made of MIS-C. He was immediately treated with IVIG, high dose steroids, and aspirin for coronary ectasia with significant improvement of symptoms in less than 36 hours. Patient recovered and was transferred to ward one week later and discharged home recovered.

Discussion: A toddler with chronic conditions and a recent SARS-CoV2 infection presented shock symptoms which led to the diagnosis of MIS-C, a life-threatening complication that can be fatal without early recognition and prompt treatment. The diagnosis of this rare syndrome is still relevant even though the pandemia ended. The importance of reassessment on the patients clinical course is important factor that should never be underestimated. But in this scenario, even more challenging in patients with several comorbidities such as this case, which can lead to fatal outcomes if misdiagnosed.