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.