ABSTRACT
Background: Incidental diagnosis of malignancy during unrelated illness is challenging, both for diagnostic clarity and therapeutic decision-making. There are reported cases of incidental discovery of Wilms tumor (WT) in the setting of trauma, but there are none reported in the setting of acute inflammatory illness, such as Multisystem Inflammatory Syndrome in Children (MIS-C), and thus no guidance regarding timing of definitive therapy. Objectives: We describe a patient with MIS-C and incidentally diagnosed WT in order to inform the management of future patients with simultaneously diagnosed malignancy and acute inflammatory illness. Design/Method: Information was obtained by retrospective review of the electronic health record. Results: A healthy 5-year-old female presented with six days of fever, cervical lymphadenopathy, urinary symptoms, and rash. Labs showed acute kidney injury, prompting imaging that revealed a left-sided renal mass, most likely a WT. The constellation of signs and symptoms was initially suggestive of obstructive uropathy resulting in urinary tract infection. However, subsequent development of conjunctivitis and oral mucosal changes, positive SARS-CoV-2 nucleocapsid antibodies, rising inflammatory markers, and mild-moderate coronary artery dilation on echocardiogram, made MIS-C the most fitting diagnosis. The patient rapidly improved after initiation of aspirin, methylprednisolone, and intravenous immunoglobulin. Cross-sectional imaging showed no metastatic disease or local tumor invasion. A multidisciplinary team of pediatric subspecialists discussed appropriate timing for upfront resection and decided to defer surgery for at least two weeks while inflammation resolved. Unfortunately, the patient continued to have ongoing inflammation requiring a prolonged steroid course, and surgery was ultimately deferred until one month following diagnosis. Surgery was uncomplicated and pathology demonstrated stage II favorable histology WT. Chemotherapy began on post-operative day 9. Conclusion: The lack of published cases of malignancy incidentally discovered during acute illness, coupled with the rapidly rising rate of pediatric cases of COVID-19 and MIS-C, present a challenge for clinicians who must treat the concurrent conditions. This report highlights the complexities of managing a WT for which upfront resection is standard in the United States. Surgery is typically performed quickly due to the fast-growing nature and risk of rupture. Reports of paraneoplastic inflammatory syndromes (non-WT) suggest that tumor resection in the setting of acute inflammation is safe, but pediatric data remains scarce. This patient's multidisciplinary team chose to delay tumor resection given the potential morbidity of major surgery in the setting of a raging inflammatory state. The patient had a favorable clinical outcome both in terms of her MIS-C and WT.
ABSTRACT
Introduction. In the context of the growing epidemic of the new coronavirus infection COVID-19, the Russian health system, for the first time in recent history, faced the need for large-scale mobilization and conversion of many existing hospitals into infectious diseases hospitals. At the same time, the composition of hospitalized patients has not been studied, and the availability of data on it is crucial for the organization and planning of medical care. Purpose of study. To study the composition of hospitalized patients with a new coronavirus infection COVID-19 from the point of view of their age, gender, the severity of the condition, the presence of pneumonia and concomitant diseases to optimize the planning and objectification of the assessment of the need for medical care in a hospital setting. Material and methods. The data was studied, and the analysis of hospitalizations of 1037 patients in the country’s largest repurposed infectious hospital for the treatment of patients with the new coronavirus infection COVID-19 was carried out. Results. For the first time analyzed the main regularities of the formation of hospitalized patients, which characterize features of the disease and have a high prognostic value both from the point of view of organization of specialized medical care in stationary conditions and assess the need for diagnostic and diagnostic and treatment activities and their resource provision. It is established that adult patients of almost all age groups receive medical care in a hospital setting, but as the age increases, the need for hospitalization tends to increase. Conclusions. The severity of hospitalized patients with COVID-19 is determined by their age and the presence of concomitant pathology, which is of important prognostic value from the point of view of optimal planning of this type of medical care. © 2021 Izdatel'stvo Meditsina. All rights reserved.