First reported case of Multisystem Inflammatory Syndrome in children in West Texas

Abstract

Research focusing on COVID-19-associated complications has become a growing area of importance. One such complication is multisystem inflammatory syndrome, a rare immune-mediated condition that most commonly presents with Kawasaki-like symptoms in the pediatric population. Potential complications include myocarditis, renal impairment, and cytokine storm. Here we describe the first reported case of multisystem inflammatory syndrome in the West Texas region, presenting in a Hispanic 5-year-old female with a recent history of COVID-19. The patient arrived to the hospital with a 4 day history of high fever, a 2 day history of diffuse maculopapular rash, and complaints of fatigue, generalized body aches, decreased appetite, headache, and abdominal pain. Further physical exam revealed hepatosplenomegaly and cervical lymphadenopathy, while labs revealed elevated inflammatory markers, lymphopenia, left shift with bandemia and immature cells, thrombocytopenia, hypoalbuminemia, and transaminitis. The patient was admitted to the pediatric intensive care unit with a suspected Kawasaki-like illness and started on high dose aspirin and IV immunoglobulin. She was placed on methylprednisolone, albumin, and acetaminophen on hospital day 3. By hospital day 4, the patient defervesced, inflammatory markers decreased, and clinical symptoms improved. The patient was discharged on hospital day 10 with absent fever and improvement of clinical symptoms for 6 consecutive days. No complications were detected upon follow-up 2 weeks later. A low threshold of suspicion for this illness is required in any child with a history of SARS-CoV-2 infection, as the presentation is vague and early identification is necessary to prevent further complications.