RESUMO
INTRODUCTION: Severe multisystem inflammatory syndrome in children (MIS-C) and severe dengue are challenging to identify during the COVID-19 pandemic in dengue-endemic areas. Fever, multiorgan involvement, and shock characterize both severe MIS-C and severe dengue. Distinguishing between the two diseases is beneficial in initiating proper management. METHODS: Medical records of children < 18 years old who were hospitalized at Hasan Sadikin General Hospital's PICU between December 2020 and July 2022 with severe MIS-C or severe dengue were recorded. Differences were assessed using comparative and descriptive analyses. RESULTS: Seventeen severe dengue patients and 4 severe MIS-C were included. The average age of severe MIS-C was 11.5 years (SD ± 2.9, 95% CI), and that of severe dengue patients was 6.2 years (SD ± 4.4, 95% CI) (p value = 0.034, 95%). Fever and abdominal pain were the most common symptoms in both groups (p = 0.471, 95% CI). Rash (p = 0.049) and nonpurulent conjunctivitis (p = 0.035) were two symptoms with significant differences. The highest platelet count (p-value = 0.006, 95% CI), AST (p-value = 0.026, 95% CI), and D-dimer level (p-value = 0.025, 95% CI) were significantly different between the two cohorts. Cardiac abnormalities were found in all (100%) severe MIS-C patients, but only one (5.9%) in severe dengue patients. CONCLUSION: Age, rash, nonpurulent conjunctivitis, platelet count, AST and D-dimer level may distinguish severe MIS-C from severe dengue fever.
RESUMO
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or corona virus disease 2019 (COVID-19) is a currently ongoing global pandemic. Children tend to show milder symptoms of infection compared to adults. Concurrently, in April 2020, there was reported an escalation of Kawasaki cases like disease in children treated in the intensive care unit and showing polymerase chain reaction (PCR) SARS CoV-2 positive. Those children had a hyperinflammatory response, which caused the failure of multi-organ and shock. Several countries have reported similar cases since then. Here we describe a case of a patient with COVID-19 and concurrent dengue infection presenting MIS-C. A 6-year-old male with no past medical history looked pale with fatigue and brought to an emergency room from a referral hospital. The patient presented with fever, acute abdominal pain, shock, and deteriorate quickly, confirmed with the serology of SARS CoV-2 IgM was reactive, serology of anti-dengue IgM was reactive and PCR SARS CoV-2 was negative. Possibly it is MIS-C coinfection with severe unusual dengue infection or MIS-C with false-positive dengue serologic test leading to a fatal outcome.
