Difficulties of differential diagnosis of multisystem inflammatory syndrome associated with SARS-CoV-2 in a teenager (clinical case)
- 作者: Konstantinova Y.E.1, Vilnits A.A.1,2, Chuprova S.N.1,3, Konev A.I.1,2, Pshenichnaya K.I.2,4, Filippova D.S.4
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隶属关系:
- Pediatric Research and Clinical Center for Infectious Disease
- Saint Petersburg State Pediatric Medical University
- North-Western State Medical University named after I.I. Mechnikov
- Consultative and diagnostic center for children
- 期: 卷 14, 编号 2 (2023)
- 页面: 105-116
- 栏目: Clinical observation
- URL: https://journals.eco-vector.com/pediatr/article/view/530230
- DOI: https://doi.org/10.17816/PED142105-116
- ID: 530230
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详细
The new coronavirus infection does not lose its relevance, which is due to the ubiquity of the virus, the variety of strains, clinical manifestations and their consequences of COVID-19. In children, one of the severe complications of new coronavirus infection is the multisystem inflammatory syndrome associated with SARS-CoV-2 (MIS-C), which is characterized by a hyperinflammatory response with damage to two or more organs and systems. MIS-C requires differential diagnosis with other diseases with similar symptoms: bacterial infections, sepsis, toxic shock syndrome, Kawasaki syndrome, hemophagocytic syndrome. As an example, the article considers a clinical case of MIS-C in a 13-year-old girl 4 weeks after undergoing new coronavirus infection (confirmed). At the onset of the disease, the leading manifestations were systemic inflammatory response syndrome (fever, increased markers of inflammation) with damage to the cardiovascular system, skin and mucous membranes, lymphadenitis, thrombocytopenia. According to the severity of the condition, the child required observation and treatment in the intensive care unit. The absence of the expected effect of the recommended MIS-C therapy (intravenous immunoglobulin and pulse therapy with methylprednisolone) on the first day did not allow to exclude bacterial infection complicated by sepsis in the above clinical situation, therefore, it was suggested that the combined course of MIS-C and bacterial infection of unspecified etiology, which probably led to a more severe course of the disease. In the outcome of the MIS-C the child had the formation of a long-term depressive state (diagnosed by a psychiatrist), for which the patient received drug therapy and psychological assistance.
The described case showed difficulties in the formulation of the final diagnosis due to the presence in the patient of several symptoms and syndromes characteristic of various diseases, the absence of an identified etiological agent and the absence of the expected positive effect with standard therapy of the disease. In addition, a pathology was revealed in the catamnesis, which required dynamic observation of the child by several specialized specialists.
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作者简介
Yulia Konstantinova
Pediatric Research and Clinical Center for Infectious Disease
编辑信件的主要联系方式.
Email: yulia.konstantinova23@mail.ru
SPIN 代码: 6301-2354
Junior Researcher of the Research Department of Intensive Care of Emergency Conditions
俄罗斯联邦, Saint PetersburgAlla Vilnits
Pediatric Research and Clinical Center for Infectious Disease; Saint Petersburg State Pediatric Medical University
Email: vilnitz@mail.ru
SPIN 代码: 8832-1211
MD, PhD, Dr. Sci. (Med.), Head of the Research Department of Intensive Care of Emergency Conditions; Associate Professor, Department of Infectious Diseases in Children of the Faculty of Postgraduate and Additional Professional Education
俄罗斯联邦, Saint Petersburg; Saint PetersburgSvetlana Chuprova
Pediatric Research and Clinical Center for Infectious Disease; North-Western State Medical University named after I.I. Mechnikov
Email: svetlana_ch_70@mail.ru
SPIN 代码: 8696-7178
MD, PhD, Senior Researcher Associate of the Research Department of Rehabilitation and Rehabilitation Therapy, Pediatric Cardiologist, Functional Diagnostics Doctor; Associate Professor, Department of Pediatrics and Pediatric Cardiology
俄罗斯联邦, Saint Petersburg; Saint PetersburgAleksandr Konev
Pediatric Research and Clinical Center for Infectious Disease; Saint Petersburg State Pediatric Medical University
Email: icdrkonev@yandex.ru
SPIN 代码: 7458-6203
Head of the Intensive Care Unit, Pediatric Research and Clinical Center for Infectious Disease; Assistant Professor of the Department of Anesthesiology, Resuscitation and Emergency Pediatrics of the Faculty of Postgraduate and Additional Professional Education
俄罗斯联邦, Saint Petersburg; Saint PetersburgKsenia Pshenichnaya
Saint Petersburg State Pediatric Medical University; Consultative and diagnostic center for children
Email: kpshenichnaya@yandex.ru
SPIN 代码: 8603-5705
MD, PhD, Dr. Sci. (Med.), Professor of the Vorontsov Department of Children's Diseases; Hematologist, Consultative and Diagnostic Center for Children
俄罗斯联邦, Saint Petersburg; Saint PetersburgDaria Filippova
Consultative and diagnostic center for children
Email: daryafilippova@bk.ru
Pediatrician, Pulmonologist
俄罗斯联邦, Saint Petersburg参考
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