12 October 2021
: Case report 
A 7-Year-Old Boy and a 14-Year-Old Girl Initially Diagnosed with Toxic Shock Syndrome and Tested Positive for SARS-CoV-2 Infection, Supporting a Diagnosis of Multisystem Inflammatory Syndrome in Children (MIS-C)
Unusual clinical course, Challenging differential diagnosis, Management of emergency care
Salvatore Giordano1ABCD, Maria Concetta Failla1ABD, Maria Grazia Li Cavoli1ABD, Domenico Romano2BEF, Veronica Vanella2BE, Chiara Caruso2B, Ilenia Chillura2B, Maria Cristina Maggio2ABCDEF*DOI: 10.12659/AJCR.931570
Am J Case Rep 2021; 22:e931570
Table 2. Case 1. Hematological findings in a 7-year-old boy with multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection.
| Data | Day 1 | Day 2 | Day 3 | Day 4 | Day 5 | Day 9 | Day 14 |
|---|---|---|---|---|---|---|---|
| Treatment | IVIG | Albumin+mPDN | Albumin | ||||
| Hb (g/dL) | 10.8 | 9.9 | 9.2 | 9.8 | 9.4 | 10.6 | 11.2 |
| WBC (/µL) | 7880 | 5380 | 11 550 | 15 780 | 15 660 | 33 380 | 20 800 |
| Neu/lymph (%) | 91.9/5.5 | 83.7/9.9 | 83.9/10.5 | 84.8/10.1 | 82.7/9.5 | 75.9/14.9 | 80.2/10.7 |
| Platelets (/µL) | 210 000 | 197 000 | 279 000 | 360 000 | 405 000 | 942 000 | 719 000 |
| CRP (range <0.5 mg/dL) | 27.79 | 24.44 | 9.36 | 5.17 | 2.93 | 1.16 | 0.15 |
| Procalcitonin (µg/L) | 176.31 | 100 | 87.93 | 35.83 | 10.03 | 1.07 | 0.31 |
| Protein/ albumin (g/dL) | 6.9/3.4 | 6.3/ | 6.5/2.5 | 6.3/2.7 | 7.1/4.4 | 8/4.1 | 8.6/4.4 |
| Creatinine (mg/dL) | 0.53 | 0.51 | 0.33 | 0.44 | 0.35 | 0.44 | 0.37 |
| Na/K/Cl (mmol/L) | 124/4.22/86 | 126/4.51/96 | 132/3.92/104 | 134/3.8/104 | 133/3.39/100 | 134/5.37/95 | 133/4.51/95 |
| Mg/P/Ca (mg/dL) | 2.53/2.4/8.9 | 2.53/4/8.2 | 1.9/2.9/7.9 | 1.95/3.5/8.1 | 3.7/8.2/8.2 | 2.49/4.6/9.3 | 2.20/3.8/9.9 |
| AST/ALT (UI/L) | 273/254 | 215/201 | 89/122 | 52/93 | 50/79 | 43/93 | 28/57 |
| CPK/LDH (UI/L) | 26/454 | 40/376 | 27/232 | 22/212 | 23/220 | 24/395 | 27/230 |
| Gamma GT (UI/L) | 307 | 256 | 184 | 162 | 132 | 38 | |
| Pancreatic amylase/lipase (U/L) | 12 | 100/216 | 136/103 | 23/17 | |||
| Troponine (ng/L) | 27.3 | ||||||
| INR/APTT | 1.37/15.3 | 0.94/28 | /24.4 | 1.01/24.8 | 1.04/25.1 | /21.7 | 0.98/20.8 |
| D-dimer | 2.79 | 2.48 | 2.9 | 2.21 | 3.06 | 4.46 | 0.73 |
| Fibrinogen | 932 | 717 | 481 | 381 | 244 | 175 | 189 |
| Ferritin | 2976 | 2134 | 1445 | 109.4 | 276.2 | ||
| Triglyceride levels | 460 | 485 | |||||
| IVIG – intravenous immunoglobulin; Hb – hemoglobin; WBC – white blood cells; Neu/lymph – neutrophils/lymphocytes; CRP – C-reactive protein; Na/K/Cl – sodium/potassium/chloride; Mg/P/Ca – magnesium/phosphorous, calcium; AST/ALT – aspartate transaminase/alanine transaminase; CPK/LDH – of creatine phosphokinase/lactate dehydrogenase. | |||||||