EP395 - MULTISYSTEM INFLAMMATORY SYNDROME (MIS-C) PRESENTING AS RETROPHARYNGEAL ABSCESS IN A 10-YEAR OLD BOY (ID 1048)
Abstract
Title of Case:
MULTISYSTEM INFLAMMATORY SYNDROME (MIS-C) PRESENTING AS RETROPHARYNGEAL ABSCESS IN A 10-YEAR OLD BOY
Background:
The multisystem inflammatory syndrome (MIS-C) associated with SARS-CoV-2 infection has various clinical presentations which are not yet fully characterized. We present a case of MIS-C in a pediatric patient initially presenting as retropharyngeal abscess.
Case Presentation Summary:
A 10-year old boy was admitted with fever, sore throat, fatigue and reduced oral intake. He had mildly enlarged bilateral cervical lymph nodes, painful limitation of lateral head movements, moderate leukocytosis and increased C-reactive protein (CRP) value (99 mg/L). A cervical CT scan revealed widening of the pre-vertebral soft tissue (up to 9 mm, extending over a length of 8.5 cm in the retropharyngeal space), consistent with retropharyngeal edema/inflammation. He was started on intravenous amoxicillin-clavulanic acid plus metronidazole. Fever persisted and 2 days afterwards he had vomiting, diarrhea, abdominal and chest pain, hypotension, tachycardia and 1st degree atrio-ventricular block on ECG. A maculopapular rash was noted, together with erythema and increased size of right cervical lymph nodes.There was further increase of CRP (230 mg/L), mild increase of serum troponin and thrombocytopenia. The patient had a history of SARS-CoV-2 infection one month ago confirmed with rapid antigen test, and positive serology for SARS-CoV-2. MIS-C was diagnosed, for which he received IVIG (2 g/kg), methylprednisolone (60 mg/day) and low-dose aspirin (100 mg/day). There was good response, and repeated cervical CT 5 days later showed almost complete resolution of the retropharyngeal inflammation. Antibiotics were discontinued.
Learning Points/Discussion:
MIS-C may occasionally present as retropharyngeal inflammation in young children. While antimicrobial treatment should not be withheld, close patient monitoring may reveal additional clinical and laboratory signs of this new syndrome, allowing timely diagnosis and appropriate treatment.
