Gökçen Erfidan1, Özgür Özdemir Şimşek1, Ahu Kara Aksay2, Gülnihan Üstündağ3, Seçil Arslansoyu Çamlar4, Fatma Mutlubaş5, Dilek Yılmaz Çiftdoğan6, Belde Kasap Demir7, Demet Alaygut5. 1. MD, Department of Pediatric Nephrology, University of Health Sciences, İzmir Tepecik Training and Research Hospital, Gaziler street No:1, 35020, Yenisehir, Izmir, Turkey. 2. MD, Associate Professor, Department of Pediatric Infectious Diseases, University of Health Sciences, İzmir Tepecik Training and Research Hospital, Gaziler street No:1, 35020, Yenisehir, Izmir, Turkey. 3. MD, Department of Pediatric Infectious Diseases, University of Health Sciences, İzmir Tepecik Training and Research Hospital, Gaziler street No:1, 35020, Yenisehir, Izmir, Turkey. 4. MD, Associate Professor, Department of Pediatric Nephrology, Izmir Faculty of Medicine, University of Health Sciences, Kazım Dirik, Sanayi Cad. No:7, 35000, Bornova, Izmir, Turkey. 5. MD, Professor, Department of Pediatric Nephrology, Izmir Faculty of Medicine, University of Health Sciences, Kazım Dirik, Sanayi Cad. No:7, 35000, Bornova, Izmir, Turkey. 6. MD, Professor, Department of Pediatric Infectious Disease, Faculty of Medicine, Izmir Katip Çelebi University, Aydinlikevler, 6782. St. No:53, 35640, Çiğli, Izmir, Turkey. 7. MD, Professor, Department of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Izmir Katip Çelebi University, Aydinlikevler, 6782. St. No:53, 35640, Çiğli, Izmir, Turkey.
Abstract
INTRODUCTION: Multisystem inflammatory syndrome in children (MIS-C) is a rarely seen severe complication of coronavirus disease-2019 (COVID-19). Although fever is one of the indispensable symptoms, other infections should be considered in the differential diagnosis during the pandemic. CASE REPORT: An 8-year-old and a 16-year-old female patient were admitted with fever, vomiting, headache. Both had fulfilled the criteria and were diagnosed with MIS-C. However, they both had remarkable persistent costovertebral angle tenderness, which was unexpected in MIS-C. In Case-1, urine analysis showed microscopic hematuria without pyuria, and urine culture showed no bacterial growth. Case-2 had microscopic hematuria and pyuria with Escherichia coli growth in urine culture. Contrast-enhanced computed tomography showed wedge-shaped hypodense multiple lesions in bilateral kidneys for Case-1, in the right kidney for Case-2. They diagnosed acute focal bacterial nephritis (AFBN). CONCLUSIONS: The diagnostic criteria of MIS-C can overlap with the symptoms of other severe septic infections such as AFBN, which is a rare urinary tract infection, diagnosed by imaging of localized renal inflammatory mass-like or wedge-shaped lesion. A detailed anamnesis and careful physical examination may help differential diagnosis. GERMS.
INTRODUCTION: Multisystem inflammatory syndrome in children (MIS-C) is a rarely seen severe complication of coronavirus disease-2019 (COVID-19). Although fever is one of the indispensable symptoms, other infections should be considered in the differential diagnosis during the pandemic. CASE REPORT: An 8-year-old and a 16-year-old female patient were admitted with fever, vomiting, headache. Both had fulfilled the criteria and were diagnosed with MIS-C. However, they both had remarkable persistent costovertebral angle tenderness, which was unexpected in MIS-C. In Case-1, urine analysis showed microscopic hematuria without pyuria, and urine culture showed no bacterial growth. Case-2 had microscopic hematuria and pyuria with Escherichia coli growth in urine culture. Contrast-enhanced computed tomography showed wedge-shaped hypodense multiple lesions in bilateral kidneys for Case-1, in the right kidney for Case-2. They diagnosed acute focal bacterial nephritis (AFBN). CONCLUSIONS: The diagnostic criteria of MIS-C can overlap with the symptoms of other severe septic infections such as AFBN, which is a rare urinary tract infection, diagnosed by imaging of localized renal inflammatory mass-like or wedge-shaped lesion. A detailed anamnesis and careful physical examination may help differential diagnosis. GERMS.
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