MIS-C Mimickers: A Case Series of Bacterial Enteritis and Sepsis Mistaken as MIS-C
Abstract
To the Editor: Multisystem inflammatory syndrome in children (MIS-C) is an uncommon manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection characterized by fever, mucocutaneous and gastrointestinal involvement, shock, and elevated inflammatory markers [1–3]. In tropical countries like India, it may be difficult to differentiate MIS-C from tropical infections and gastroenteritis (bacterial/viral) due to overlapping features [4]. We present 9 children who presented during the surge of MIS-C (January–June 2021) with fever, gastrointestinal symptoms, and raised inflammatory markers raising suspicion of MIS-C. Other features noted were erythematous rash, conjunctival injection, and seizures and encephalopathy in 3 each; respiratory distress in 1, shock and myocardial dysfunction in 4, and multiorgan dysfunction syndrome in 2 children. Investigations revealed neutrophilia, thrombocytopenia, hyponatremia, elevated D-dimers, CRP, and ProBNP in all; and elevated procalcitonin and IL-6 in 7 children. None had history of exposure or illness suggestive of SARSCoV-2 infection in recent past or positive RT-PCR; and 5 had positive SARS-CoV-2 antibodies. The blood cultures grew Salmonella typhi in 7 cases; and Escherichia coli and Enterococcus raffinosus in 1 each. Workup for tropical infections (scrub typhus, malaria, and dengue) was negative. Management included broad-spectrum intravenous antibiotics (ceftriaxone and doxycycline) in all; fluid boluses and…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 9 participants or records.
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