MIS-C with Neurologic Features

Multisystem Inflammatory Syndrome in Children (MISC-C) is a systemic inflammatory disorder associated with novel COVID-19. Children diagnosed with COVID-19 typically experience mild viral symptoms, however, in rare instances more severe disease will develop. Current epidemiology states \u3c1% of children diagnosed with COVID will develop complications of MIS-C. Symptoms of MIS-C are varying, but in general include abnormal vital signs (tachycardia, tachypnea), Kawasaki-like symptoms, respiratory distress, cardiac involvement, and shock like symptoms. Abdominal pain, features of acute kidney injury, coagulopathy, and neurologic dysfunction have also been reported. It is currently recommended for children with any combination of the above symptoms to be hospitalized and treated for MIS-C, given the potential for severe consequences. This case presentation aims to highlight the neurologic symptoms that can occur with the diagnosis of MIS-C. Current estimations predict 20% of children with MIS-C will develop more severe central nervous system symptoms. Our patient presented with neuropsychiatric symptoms, which has little documentation in current medical literature. Initial presentation, differential diagnosis, hospital workup, and treatment of disease will be discussed. Our case is a previously healthy 8yo male with past medical history of ADHD. He presented to the Emergency room with chief complaints of fever, confusion, and visual and motor hallucinations 3 weeks after receiving a positive COVID test. Prior to the date of presentation, the patient’s only symptom of COVID 19 was rhinorrhea. ED workup revealed tachycardia, pallor and erythema/swelling of fingers, facial rash, abdominal pain, and leukocytosis. Initial differential diagnosis included sepsis secondary to urinary tract infection versus encephalopathic MIS-C. Labs at presentation showed CRP and D-dimer within normal limits, and treatment for UTI was initiated. For the first few days of hospital stay, patients condition was unchanged and inflammatory marker levels rose. The patient also showed sustained tachycardia, fever, widened pulse pressures, nocturnal incontinence, and one episode of bigeminy. Treatment targeting MIS-C with, IV ceftriaxone, vancomycin, IVIG, methylprednisone, and aspirin was begun. Inflammatory markers subsequently began to downtrend and patients condition began to improve. This case study highlights central nervous system features as a potential primary presenting symptom of MIS-C. Currently, there is little literature on COVID 19 associated psychosis. Further research is needed to assess the underlying potential inflammatory mechanisms responsible for our patient’s visual and motor hallucinations resulting from MIS-C