Diagnostic challenges of old diseases in the COVID-19 era: a report of two cases of carbamazepine-induced DRESS syndrome.

INTRODUCTION: A new MIS-C that develops after the acute stage of COVID-19 infection has recently been reported worldwide. Drug reaction with eosinophilia and systemic symptoms syndrome is a rare but potentially severe adverse drug-induced reaction most commonly associated with anticonvulsants. Due to variability in clinical presentation involving cutaneous and multiorgan systems, broad differential diagnosis, and lack of definitive diagnostic tests, diagnosis may be delayed. CASE REPORTS: The authors report 2 cases of pediatric patients who presented with fever, diffuse rash, and exposure to COVID-19 infection with suspected MIS-C. Both patients' medical histories revealed carbamazepine treatment for approximately 2 months. The diagnosis of DRESS syndrome was associated with the use of carbamazepine. CONCLUSIONS: Distinguishing between MIS-C and DRESS syndrome may be difficult due to similar clinical and laboratory features and the lack of definitive diagnostic tests for either condition. When encountering cases like the current report, it is important to consider DRESS syndrome for early diagnosis and medical intervention.

Comparison of clinical and laboratory features in coronavirus disease 2019 and pediatric multisystem inflammatory syndrome patients.

BACKGROUND: The coronavirus disease 2019 (COVID-19) and pediatric multisystem inflammatory syndrome (PIMS) are a major public health issue affecting many people worldwide. Although there are new studies in children, little is known about these two new conditions. The aim of this study was to evaluate and compare the clinical and laboratory features of children with COVID-19 and PIMS. METHODS: We conducted a prospective, single-center study of pediatric COVID-19 and PIMS at a tertiary care hospital in Turkey between November 2020 and March 2021. RESULTS: A total of 115 patients with COVID-19 and PIMS were examined during the study period. The median age was 60 (range, 1-215) months and 64% of the patients were male. The most common clinical symptoms were fever (70%) and cough (43%). Conjunctivitis and skin rash were not seen in PIMS patients. Of all patients, 64% had a history of close contact in household. Lymphopenia was present in 34/115 (30%) patients. Acute phase reactants were significantly higher in PIMS patients. Abnormal chest computed tomography scan findings were detected in 68% of the patients, while 36% had abnormal echocardiographic findings. In multivariate analysis, longer duration of fever, diarrhea, lower thrombocyte and higher neutrophil count were significantly associated with diagnosis of PIMS. The treatment included antibiotics, favipiravir, intravenous immunoglobulin, corticosteroids, interleukin-1 blockade. and supportive therapy. Seven patients (6%) required intensive care support. All patients were discharged without any complications, except one who died. CONCLUSIONS: Longer duration of fever, diarrhea, lower thrombocyte, and higher neutrophil count can warn clinicians for diagnosis of PIMS.