key: cord-0854156-b3h25sv9
authors: Joghee, Sunil; Kanthasamy, Neminathan; Lakshmanan, Senthil Kumar
title: Multisystem Inflammatory Syndrome in Children Presenting as Subacute Intestinal Obstruction
date: 2021-09-06
journal: Indian J Pediatr
DOI: 10.1007/s12098-021-03949-5
sha: 923ad6cfa1bc7a5da30c84af6d1d7f50c02101af
doc_id: 854156
cord_uid: b3h25sv9

nan

To the Editor: A 9-y-old girl was admitted with fever and vomiting for 3 d, not passing stools for 2 d, abdominal pain and fullness for 1 d. She was febrile (105 °F), dehydrated, and tachycardic; there was abdominal distension with generalized tenderness and sluggish bowel sounds. Abdominal radiograph showed multiple air fluid levels in the abdomen suggestive of intestinal obstruction. She was kept nil by mouth with continuous nasogastric tube aspiration which showed minimal bilious aspirates. She was started on intravenous fluids and empirical antibiotics pending cultures.

Blood investigations showed neutrophilic leukocytosis, mild thrombocytosis, and elevated erythrocyte sedimentation rate (ESR -60 mm/h) and C-reactive protein (CRP -31 mg/dL); urinalysis was normal. Serum lipase and amylase were mildly raised and transaminases were normal. RT-PCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative. Serology for SARS-CoV-2 showed elevated IgG titer (538 AU/mL). Further investigation revealed elevated troponin-T, N-terminal prohormone of brain natriuretic peptide (NT pro-BNP) and D-dimer. Echocardiography showed mild left ventricular dysfunction. Dengue serology and Typhidot IgM were negative. Blood culture was sterile. A diagnosis of multisystem inflammatory syndrome in children (MIS-C) was made as she fulfilled the WHO criteria [1] . She was treated with intravenous immunoglobulin (IVIG), low-dose methyl-prednisolone and aspirin. Her symptoms resolved gradually. Repeat inflammatory markers and echocardiography were normal at 2 wk follow-up.

Gastrointestinal (GI) symptoms like vomiting, diarrhea, and abdominal pain have been reported in up to 90% children with MIS-C [2] . However, there are only a few case reports of MIS-C presenting with features of intestinal obstruction [3, 4] . To the best of our knowledge, this is the first case of MIS-C presenting with features of intestinal obstruction reported in India. We believe MIS-C should be considered in the differential diagnosis of children presenting with features of intestinal obstruction, especially during the ongoing pandemic.

WHO. Multi system inflammatory syndrome in children and adolescents temporally related to COVID-19. Available at

Characteristics and outcomes of US children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19

Features of intestinal disease associated with COVID-related multisystem inflammatory syndrome in children

Abdominal Imaging findings in critically Ill children with multisystem inflammatory syndrome associated with COVID-19