Multisystem inflammatory syndrome in children (MIS-C) of a toddler initially presenting with fever and pyuria

• Published in: BMJ case reports Vol. 17; no. 1
• Main Authors: Lo, Kinyui Alice, Goh, Lee Gan, Ramachandran, Rajeev
• Format: Journal Article
• Language: English
• Published: England 03-01-2024
• Subjects: Aftercare; Child, Preschool; Conjunctivitis; COVID-19 - complications; Fever - etiology; Humans; Male; Patient Discharge; Pyuria; Systemic Inflammatory Response Syndrome - diagnosis; COVID-19; Urinary tract infections; Primary Care; Paediatrics
• ISSN: 1757-790X
• DOI: 10.1136/bcr-2022-253756

We report a case of multisystem inflammatory syndrome in children (MIS-C) in an East Asian toddler. He presented with a 2-day history of fever and pyuria, 5 weeks before that he had recovered from COVID-19. He was initially treated as urinary tract infection. On day 5 of fever, he was noted to have bilateral non-suppurative limbus-sparing conjunctivitis, red and cracked lips and erythematous extremities. Investigations showed raised inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), thrombocytopenia and a markedly elevated NT-proBNP. He received prompt and appropriate treatment inpatient; however, he still had mild coronary abnormalities at 9 months postdischarge. The aim of this paper is to describe the initial presentation and progress of a case of MIS-C. The unique features of this case are his initial presentation of pyuria and notably, his demography (young age, East Asian) which is more typical of Kawasaki disease than MIS-C.