GI Issues in Kids With COVID-19 MIS-C May Muddy Diagnosis
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Children and adolescents with COVID-19 who developed multisystem inflammatory syndrome (MIS-C) often exhibited marked gastrointestinal (GI) manifestations, sometimes confounding diagnosis by mimicking GI infections or inflammatory bowel disease (IBD), according to a recent case series.

In a chart review of 44 pediatric patients hospitalized for COVID-19-related MIS-C, GI symptoms were prominent in 84.1% of cases and were commonly accompanied by fever and rash. However, unlike adult patients, only 25% of the pediatric patients in the case series required supplemental oxygen, and only one required intubation.

Some 30% had within the past 7 days visited an emergency department or urgent care center for less severe symptoms, such as fever and GI symptoms mimicking viral gastroenteritis, including nausea, vomiting, and diarrhea. No other systemic symptoms were evident.

Of the 27% of patients who had an infectious PCR panel performed on stool, none had an identified infection. The majority of cases at admission had markedly elevated inflammatory markers: ESR median of 59 and CRP median of 146.5. They also had mildly decreased albumin, and 52.3% had elevated transaminases. Just one patient had lipase elevated to more than three times the upper limit of normal.

MIS-C, a condition involving systemic hyperinflammation with fever and multisystem organ dysfunction similar to the symptomatic profile of Kawasaki disease, should therefore be considered in patients who present with prominent GI symptoms, and a history of recent SARS-CoV-2 exposure, according to the authors. Long-term follow-up of possible organ dysfunction may warrant surveillance for IBD, Researchers added.

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