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

dc.creatorMahajan, Anisha
dc.creatorMurray, Celeste
dc.creatorMurray, Tyler
dc.creatorShahin, Dani
dc.creatorEspino, Lynette
dc.creatorJalfon, Rachel
dc.creatorAnvaripour, Navid
dc.description.abstractMultisystem 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.
dc.titleA Case Report of Multisystem Inflammatory Syndrome in Children Presenting as Typhus