Document Type : original article
Authors
- Suraksha Ramakrishna Sharma 1
- Mahendrappa kotyal 2
- Surbhi Pravin Rathi 3
- Santosh Kondekar 4
- Praveen Unki 5
- Ankita Chamanna 6
- Jagdish Chandrakant Taur 7
1 department of pediatrics, junior resident, topiwala national medical college and BYL Nair Ch hospital, Mumbai, India
2 pediatrics, professor and head, Adichunchangiri institute of medical science b g nagara, Mandya district, Karnataka
3 pediatrics, professor and head, Topiwala national medical college, BYL Nair Ch hospital, Mumbai 400008
4 Pediatrics, Associate professor, Topiwala National medical college, BYL Nair, Ch hospital Mumbai 400008
5 Topiwala national medical college, BYL Nair Ch hospital, Mumbai 400008
6 pediatrics, junior resident, Adichunchangiri institute of medical science, B G nagara, Mandya district, Karnataka
7 pediatric, junior resident, Topiwala national medical college, BYL Nair Ch hospital, Mumbai 400008
Abstract
Background: Multisystem Inflammatory syndrome in Children (MIS-C) is a common diagnosis among children in the post Covid-19 era, which usually presents with fever and varied systemic manifestations. BCG vaccination site reaction as a manifestation of MIS-C is barely ever documented. In this series, we present a rare such case report along with the other six other cases.
Results: Seven cases with MIS-C are presented with four male and three female children. The median age of presentation was 3 (range: 0.4-14) years. Fever was the most common (100%) symptom followed by muco-cutaneous manifestation (50%,4/7), and gastrointestinal symptoms (37.5%,3/7) and cardiovascular (37.5%,3/7). The clinical feature which led to the diagnosis include BCG site vaccination, erythema multiforme, periungual and perineal peeling, unilateral knee joint effusion, skin scalding syndrome, urticaria, and acute glomerulonephritis. The initial work-up for fever did not yield any cause in all the cause except for a non-specific elevation of inflammatory markers. 6 cases had elevated anti-SARS-Co-V2 antibody titres with a negative RTPCR/RAT test and 1 case yielded positive RTPCR for covid status for acute infection. 2D Echocardiography showed Coronary artery dilatation in two patients which resolved on follow-up. All the patients responded well to intravenous immunoglobulin and methylprednisolone combination therapy with antiplatelet drugs.
Conclusion: BCG vaccination site reaction could occur due to antigen-homology. Cardiovascular manifestations (coronary artery dilatation) without hemodynamic instability may also be a manifestation of MIS-C, thereby placing 2D-Echo as an important step in diagnostic workup.
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