Acute Kidney Injury in Multisystem Inflammatory Syndrome in Children (MIS-C): a Case Report
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COVID-19
Acute Kidney Injury in Multisystem Inflammatory Syndrome in Children (MIS-C): a Case Report Melissa Lee 1 & Mark Hilado 1 & Sarah Sotelo 1 & Lawrence M. Opas 1,2 & Daniel D. Im 1,2 Accepted: 16 November 2020 # Springer Nature Switzerland AG 2020
Abstract A 15-year-old female with no significant past medical history who presented with abdominal pain, vomiting, and diarrhea, found to be in acute renal failure and was subsequently diagnosed with multisystem inflammatory syndrome in children (MIS-C). Critical manifestations seen in pediatric COVID-19 can be varied affecting different organ systems. Pediatric providers, during a pandemic with imperfect testing, must be keenly aware of how varied the pathogenesis of COVID-19 can be in children. Keywords COVID-19 . MIS-C . Renal failure . AKI
Abbreviations PICU ARDS MIS-C COVID-19 SARS-CoV-2 BIPAP
Pediatric Intensive Care Unit Acute respiratory distress syndrome Multisystem inflammatory syndrome in children Coronavirus disease 2019 Severe acute respiratory syndrome coronavirus-2 Bi-level positive airway pressure
Introduction Severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) has been found to cause a range of symptoms and disease states; however, the varied critical manifestations in children remain not well described. Most cases of SARSCoV-2 identified in children and adolescents have been asymptomatic, mild, or moderate, with only 2.1% being severe, and 1.2% being critical—with critical COVID-19 defined as children who can quickly progress to acute respiratory This article is part of the Topical Collection on Covid-19
distress or respiratory failure, and may also have shock, encephalopathy or heart failure, coagulation dysfunction, and acute kidney injury, including multiple organ dysfunction [1]. The mortality rate in children and adolescents is reported at 0 to 0.09% [1, 2]. In children and adolescents who are symptomatic, the most frequent symptoms are fever, cough, and diarrhea [2]. In one systematic review of literature reporting pediatric SARS-CoV-2 infection only 2% required PICU level care or mechanical ventilation [3]. A COVID-19 manifestation described that is unique to the pediatric population, multisystem inflammatory syndrome in children (MIS-C; also interchangeably known as pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 or PIM-TS) is a post-COVID infectious multisystem inflammatory state that can develop in children and holds clinical and laboratory similarities with other pediatric inflammatory diseases such as Kawasaki disease and toxic shock syndrome. The pathophysiology is still unclear, and clinical features are variable. The Centers for Disease Control case definition specifies that the patient be < 21 years old, have “fever, laboratory evidence of inflammation, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement,” in the absence of an “alternative plausible diagnosis,” and evidence of SARS-CoV-2 infection or exposure [4].
* Daniel D.
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