Clinical Scenario:
A 12-year-old previously healthy boy is brought to the emergency department with a 6-day history of high-grade fever, abdominal pain, vomiting, and diarrhea. His parents report that he had a mild respiratory illness 5 weeks ago after several family members tested positive for COVID-19. On examination, he is febrile (39.5°C), tachycardic, hypotensive, and has bilateral non-purulent conjunctivitis, cracked lips, and a generalized erythematous rash. Laboratory investigations reveal markedly elevated CRP, ferritin, D-dimer, and troponin levels. Echocardiography demonstrates mild left ventricular dysfunction.
Which of the following is the most likely diagnosis?
A. Acute COVID-19 pneumonia
B. Kawasaki disease
C. Multisystem Inflammatory Syndrome in Children (MIS-C)
D. Septic shock due to bacterial infection
E. Toxic shock syndrome
Correct answer & Explanation:
Correct Answer: C. Multisystem Inflammatory Syndrome in Children (MIS-C)
Discussion: Multisystem inflammatory syndrome in children ( MIS-C)
MIS-C is a severe post-infectious hyperinflammatory syndrome occurring typically 2–8 weeks after SARS-CoV-2 infection. The condition is characterized by persistent fever, elevated inflammatory markers, gastrointestinal symptoms, mucocutaneous findings, cardiovascular dysfunction, and evidence of recent COVID-19 infection or exposure.
The distinguishing features in this case include:
Recent COVID-19 infection (5 weeks earlier)
Persistent fever
Gastrointestinal symptoms
Rash and conjunctivitis
Shock
Elevated inflammatory markers
Myocardial involvement (elevated troponin and ventricular dysfunction)
These findings strongly support MIS-C rather than acute COVID-19 infection.
