A Young Adolescent With MIS-C-Like Illness During COVID-19

Case Presentation

A young adolescent female aged 13 years presented with a history of fever for five days and a blanchable rash. Apparently, the child was doing well on antiepileptic drugs until five days prior to the date of her admission to the hospital. History of the child's exposure to a COVID-19 patient in last four weeks could not be ascertained. There was no history of travel to a COVID-19 containment zone and no history of immunization against COVID-19 because the trials were still going on, and the authorities had not issued any directives for immunizing children with the COVID-19 vaccine.

Past Medical History

The child has a known diagnosis of non-structural electrical status epilepticus (ESES) in sleep, diagnosed in 2019. The child has been on steroids and antiepileptic drugs. The seizures have been under control since the start of treatment.

Developmental History

No significant developmental history. Immunizations are up to date according to the Centers for Disease Control and Prevention (CDC) immunization schedule.

Family and Social History

The child is a resident of India, enrolled in elementary education, and belongs to a middle-class family. Her father is a government servant, and her mother is a homemaker. The child has one brother two years younger than she is.

Physical Examination

The young adolescent presented with a history of fever for five days (103o F) not associated with chills and rigors in the emergency department of our hospital. Along with fever, there were bilateral blanchable maculopapular rashes in cephalo-caudal fashion, reduced activity, and lethargy for two days. On examination, the child was conscious, pupils bilateral, equal, and reacting to light, febrile (103o F), RR was 56/min, nasal flaring present, HR 154/min, cap refill less than two seconds, BP (MAP) 131/89/105 mmHg, occasional ecchymosis patches present on the face, upper extremities, abdomen, and lower extremities of the child. No distended neck veins. Respiratory system examination: tachypnea and nasal flaring were present, bilateral air entry was equal, no added sounds. Cardiovascular system examination: tachycardia (HR 154 beats/minute) was observed otherwise S₁, S₂ heard normally, and CFT less than 2 seconds, BP (MAP) 131/89/105 mmHg.

Diagnostic Studies

Blood samples for CBC, VBG, blood culture, coagulation profile, inflammatory markers, and COVID-19 (rapid antigen test) were taken. The cartridge-based nucleic acid amplification test for COVID-19 was negative. Echocardiography showed a normal ejection fraction, with no valvular abnormalities. Chest X-ray and chest CT revealed right perihilar infiltrate and right paratracheal lymph nodes with left minimal pleural effusion.