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POS-934 ATYPICAL MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN (MIS-C) PRESENTING AS GROSS ASCITES IN A CHILD WITH END STAGE KIDNEY DISEASE
Kidney International Reports ; 7(2):S407-S408, 2022.
Article in English | EMBASE | ID: covidwho-1706951
ABSTRACT

Introduction:

Mankind has been ravaged by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since 2019. To date, we are still battling with coronavirus disease 2019 (COVID19). Although children seem to experience milder symptoms with acute COVID19 illness, some are burdened by multisystem inflammatory syndrome in children (MIS-C) that classically observes a temporal relationship with COVID19.

Methods:

Clinical data retrieved from medical records and hospital electronic database with permission.

Results:

We report herein a 7-year-old incident dialysis patient with an atypical presentation of MIS-C. He had previously experienced recurrent peritoneal dialysis-related peritonitis, which resulted in the removal of his tenckhoff catheter and was subsequently on chronic hemodialysis. He developed COVID-19 pneumonia after adults in the family caught the infection. The child experienced an uneventful recovery with nasal oxygen supplementation and a course of steroids. However, he developed gross abdominal distension approximately three weeks post COVID-19 which was not associated with fever or abdominal tenderness. A bedside ultrasound of the lungs suggested a normohydrated state with no signs of increased extravascular lung water. Simple ascites was demonstrated on ultrasound of the abdomen with a serum-ascites albumin gradient (SAAG) of less than 1.1g/dL and an ascitic protein of 48g/L. The sample had a normal fluid cytology and was negative for bacterial, fungal and mycobacterial cultures. Interestingly, our patient had remarkably high inflammatory markers ie C-Reactive Protein (CRP) 111 mg/L, Procalcitonin 7.47 ng/mL, D-Dimer >7.65 mcg/mL and Ferritin 1650 mcg/L despite the absence of fever. The liver enzymes and complete blood counts were unremarkable apart from transient reactive thrombocytosis. His echocardiogram showed minimal pericardial effusion and the absence of coronary arteries dilatation. In the light of his complex clinical presentation, temporal relation with recent COVID-19 and unexplained signs of hyperinflammation, he was treated with Intravenous Immunoglobulin 2g/kg. Following that, we observed steady improvement of the inflammatory markers and resolution of the reactive ascites. At the time of writing, six weeks lapsed and he remained well on chronic hemodialysis.

Conclusions:

In conclusion, the exorbitantly high inflammatory markers and gross ascites otherwise unexplained by another disease proess could reflect an immune dysregulation post COVID-19 or an atypical presentation of MIS-C. Much is yet to be known of this very complex disease in children. No conflict of interest
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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Kidney International Reports Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Kidney International Reports Year: 2022 Document Type: Article