SHM Converge Scientific Abstract ePoster Gallery-A Near Mis-C

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This case describes a 13-year-old girl with no prior medical history who presented with 1 week of vomiting, body aches, epigastric abdominal pain, intermittent fevers, diarrhea, decreased oral intake, and exertional shortness of breath. On exam, she was febrile, tachycardic, hypoxic with ambulation, dehydrated, and had decreased breath sounds with crackles at the bases. Initial treatment included remdesivir and dexamethasone for possible COVID pneumonia, along with ampicillin and azithromycin for community-acquired pneumonia.<br /><br />Because of her inflammatory labs and respiratory symptoms, she was transferred to a tertiary center for concern for multisystem inflammatory syndrome in children (MIS-C). She received IVIG, enoxaparin, and aspirin. However, chest CT showed bilateral ground-glass opacities with posterior lower-lung consolidation and subpleural sparing, findings that raised concern for e-cigarette or vaping product use-associated lung injury (EVALI). After further discussion, she admitted to regular vaping over the prior few months, confirming the importance of repeated, sensitive social history taking in adolescents.<br /><br />Her workup showed markedly elevated inflammatory markers, including CRP, ESR, D-dimer, fibrinogen, and procalcitonin, with neutrophilic leukocytosis. COVID antibody was positive but PCR was negative, and infectious studies were otherwise negative. Cardiac evaluation was reassuring, including normal echocardiogram, though troponin and proBNP were elevated.<br /><br />The key teaching point is that MIS-C and EVALI can look very similar clinically and on laboratory testing, including fever, elevated inflammatory markers, and oxygen requirement. CT imaging and accurate social history are crucial to distinguishing them. EVALI is more associated with neutrophilic leukocytosis, lack of recent COVID infection, and subpleural sparing on CT. The patient improved, was weaned off oxygen, completed azithromycin, and was discharged with pulmonary follow-up and no lingering pulmonary issues.

Asset Subtitle

Danielle Halpern

Meta Tag

Author List Danielle Halpern

Category Clinical Vignettes

Concept Multisystem Inflammatory Syndrome in Children

Concept E-cigarette or Vaping-Associated Lung Injury

Concept Diagnosis of Exclusion

Concept Inflammatory Marker

Concept D-dimer

Distinguished Non-Finalist

Presenter Organization Brigham and Women's/Boston Children's Hospital

Presenting Author Danielle Halpern

Track Pediatric

Keywords

MIS-C

EVALI

vaping

adolescent

ground-glass opacities

subpleural sparing

COVID-19

inflammatory markers

respiratory distress

chest CT

Multisystem Inflammatory Syndrome in Children

E-cigarette or Vaping-Associated Lung Injury

Diagnosis of Exclusion

Inflammatory Marker

D-dimer