CASE 2
A three-year-old previously healthy girl admitted to our hospital with
fever of four days. Her father attended the funeral of relative passed
away due to COVID-19 one month ago, after which he had fever for two
days. Apart from this, there was no other exposure that would suggest
COVID-19. Her physical examination revealed 38.1°C fever and tachycardia
(160/min). There were widespread maculopapular rashes on her body and
abdominal tenderness with no organomegaly. Her lips were red and
cracked. She had edema on her eyelids and extremities.
Laboratory findings showed marked thrombocytopenia, lymphopenia and
elevated liver enzymes (Table1). High CRP, procalcitonin and interleukin
6 (IL-6) levels were present. Ferritin and D-dimer level were high
(Table 1). Cardiac enzymes were in between normal ranges. Her SARS-CoV-2
RT-PCR was negative and SARS-CoV-2 IgG was positive; 9.1.
Echocardiographic findings were normal (EF: 77%).
She was hospitalized with the diagnosis of MIS-C and started on IVIg
(2gr/kg/day), methylprednisolone (2mg/kg/day), anakinra (4mg/kg/day) and
enoxaparin (1mg/kg/day). Hemophagocytosis with increased number of free
histiocytes was present on BMA (Figure 2 C&D). On the fifth day of the
treatment, she was well with improved laboratory findings.