The Study
Patient 1 was a 15-year-old girl with asthma who received her first dose of BNT162b2 6 days before seeking care. She had low-grade fever and myalgia, which resolved within 2 days of vaccination. Four days later, she experienced 102°F fevers, headaches, nonbilious emesis, myalgias, chest pain, and a rash. Emergency department (ED) examination identified pharyngeal erythema, bilateral conjunctivitis, and a diffuse blanching rash. She had no respiratory or cardiovascular symptoms. At admission, laboratory test results showed leukocytosis with polymorphonuclear cell predominance and elevated CRP, fibrinogen, prothrombin time, brain natriuretic peptide (BNP), and D-dimer (Table). Urinalysis revealed trace protein, large blood, moderate leukocyte esterase, 10–20 leukocytes per high-powered field, and 1+ bacteria. Results of nasopharyngeal SARS-CoV-2 reverse transcription PCR were negative. Further tests included chest radiograph, chest computed tomography angiography, electrocardiogram, and echocardiogram; all results were unremarkable. She was admitted to the pediatric intensive care unit (ICU) and given 2 g/kg intravenous immune globulin (IVIG) for suspected of MIS-C. Symptoms rapidly improved. Leukocyte level decreased to 11.0 K/uL and D-dimer to 2.5 mg/L within 48 hours. The patient remained hemodynamically stable throughout admission and was afebrile with improved symptoms when she was discharged 3 days after admission. SARS-CoV-2 antibody test results at discharge were positive for nucleocapsid but negative for spike. Two days after discharge, the patient returned to the ED for throbbing headaches, nausea, and fatigue. CRP had downtrended since discharge to 2.71 mg/L. Magnetic resonance venography results were normal and she was discharged on antimigraine medication.
