A Case Report of Multisystem Inflammatory Syndrome in Children Presenting as Typhus

Multisystem Inflammatory Syndrome in Children (MIS-C) is described as a set of life-threatening clinical symptoms arising secondary to an inflammatory response triggered by SARS-CoV-2 infection, typically manifesting 25 days after initial symptom onset. Considerations for diagnosis include age < 21, fever, laboratory evidence of inflammation, and previous SARS-CoV-2 exposure or infection. MIS-C presents similarly to endemic or murine Typhus caused by Rickettsia typhi. Both pathologies present with Kawasaki's Disease-like features of fever, rash, conjunctivitis, and lymphadenopathy. Additional shared non-specific symptoms include headache, pharyngitis, abdominal pain, and diarrhea. Furthermore, they share similar inflammatory markers and laboratory values, including elevated ESR, elevated ALT, and anemia. Here, we report a case of MIS-C initially misdiagnosed as murine Typhus. A 15-year-old male presented with symptoms of murine Typhus to a hospital in an endemic region. Due to a positive Rickettsia panel, doxycycline was initiated to treat suspected murine Typhus. The patient did not improve, and additional differential diagnoses were considered. Clinical suspicion for MIS-C was heightened due to self-reported history of COVID-19 infection one month prior. Anti-inflammatory treatment with intravenous immune globulin, methylprednisolone, and anakinra was initiated to symptomatically treat MIS-C. This therapeutic regimen resulted in patient stabilization and discharge, thus corroborating diagnosis of MIS-C. Due to the shared clinical manifestations of murine Typhus and MIS-C secondary to COVID-19, we recommend MIS-C as a differential for a patient presenting with characteristic symptoms.