Jeanette T Beaudry1,2, Barbara Dietrick1, Dawn B Lammert1, Alexander Constas3, Julia McCaw3, John Hammond1, Matthew Buendia1, Julie E Stein4, Andrew Pekosz5, Jennifer Schuette3, Heba H Mostafa6, Jody E Hooper4, Meghan Bernier3, Allison Agwu2,7, Leonard S Feldman1,7. 1. Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland. 2. Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland. 4. Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland. 5. Microbiology and Immunology, Johns Hopkins University School of Public Health, Baltimore, Maryland. 6. Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. 7. Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), an entity in children initially characterized by milder case presentations and better prognoses as compared with adults. Recent reports, however, raise concern for a new hyperinflammatory entity in a subset of pediatric COVID-19 patients. METHODS: We report a fatal case of confirmed COVID-19 with hyperinflammatory features concerning for both multi-inflammatory syndrome in children (MIS-C) and primary COVID-19. RESULTS: This case highlights the ambiguity in distinguishing between these two entities in a subset of pediatric patients with COVID-19-related disease and the rapid decompensation these patients may experience. CONCLUSIONS: Appropriate clinical suspicion is necessary for both acute disease and MIS-C. SARS-CoV-2 serologic tests obtained early in the diagnostic process may help to narrow down the differential but does not distinguish between acute COVID-19 and MIS-C. Better understanding of the hyperinflammatory changes associated with MIS-C and acute COVID-19 in children will help delineate the roles for therapies, particularly if there is a hybrid phenotype occurring in adolescents.
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), an entity in children initially characterized by milder case presentations and better prognoses as compared with adults. Recent reports, however, raise concern for a new hyperinflammatory entity in a subset of pediatric COVID-19 patients. METHODS: We report a fatal case of confirmed COVID-19 with hyperinflammatory features concerning for both multi-inflammatory syndrome in children (MIS-C) and primary COVID-19. RESULTS: This case highlights the ambiguity in distinguishing between these two entities in a subset of pediatric patients with COVID-19-related disease and the rapid decompensation these patients may experience. CONCLUSIONS: Appropriate clinical suspicion is necessary for both acute disease and MIS-C. SARS-CoV-2 serologic tests obtained early in the diagnostic process may help to narrow down the differential but does not distinguish between acute COVID-19 and MIS-C. Better understanding of the hyperinflammatory changes associated with MIS-C and acute COVID-19 in children will help delineate the roles for therapies, particularly if there is a hybrid phenotype occurring in adolescents.
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