Post-covid Multisystem Inflammatory Syndrome in children (Mis-C) with rare gastrointestinal ramifications: Case reports from a Tertiary Care Hospital in Eastern India

Abstract

Children with prior coronavirus disease 2019 (COVID-19) infection display an increased systemic inflammation causing multiorgan dysfunctions in the cardiovascular, respiratory, central nervous system, and gastrointestinal (GI) systems, known as MIS-C, that is, multisystem inflammatory syndrome in children. Most of the MIS-C cases have GI manifestations like pain abdomen, loose motion, vomiting or nausea, elevated liver enzymes, ileus, and bleeding. Angiotensin-converting enzyme 2 (ACE2) receptors in the terminal ileum and colon are responsible for the majority of ACE2-induced damage to these tissues. In the pandemic's second wave, a significant number of MIS-C patients with predominantly GI symptoms (around 80%) were reported. Although different molecular inflammatory mechanisms are involved, there is a significant overlap of the children's GI symptoms with those of MIS-C and other conditions of the abdomen caused by infection or inflammation, thus resulting in a diagnostic dilemma. Here, we report two cases of MIS-C with acute appendicular perforation and ileal perforation needing both medical management and surgical intervention.

Keywords

• appendicular perforation
• child
• covid-19
• gastrointestinal symptoms
• ileal perforation
• mis-c