The challenges of multisystem inflammatory syndrome diagnosis and treatment

A two-year-old girl with fever, diarrhea and vomiting was presented to the Emergency Department (ED). maculopapular rash on face, cervical lymphadenopathy 1st degree dehydration were being noted. Laboratory results showed leukocytosis, neutrophilia a high level of C-reactive protein (CRP). Amoxicillin prescribed, but patient’s state did not improve. She returned ED all over her body 2nd dehydration. revealed thrombocytopenia more increased CRP. It found that mother has been diagnosed coronavirus disease approximately two months ago. Extended laboratory signs mild anemia, levels liver enzymes, procalcitonin, troponin, N-terminal prohormone brain natriuretic peptide, D-dimers, ferritin. Anti-SARS-CoV-2 (severe acute respiratory syndrome-coronavirus) IgG (immunoglobulin G) detected. Multisystem inflammatory syndrome diagnosed. Pediatric echocardiography 10 mm fluids in pericardium, I mitral valve regurgitation, dilated left coronary artery. given treatment intravenous Immunoglobulin G, methylprednisolone aspirin, Tocilizumab given, it have much positive effect, progressed leucocytosis neutrophilia. As last resort, biology recombinant form human interleukin-1 receptor antagonist Anakinra started after week symptoms changed, regressed.