Complications of Covid-19 are easily confused with appendicitis

Ho Chi Minh CityAn 8-year-old boy with a multisystem inflammatory complication caused by Covid-19, presented with high fever, abdominal pain, and vomiting similar to appendicitis.

On January 21, Doctor Nguyen Minh Tien (Deputy Director of the City Children’s Hospital) said that two days before admission, the child had a continuous fever of 39-40 degrees Celsius, taking fever-reducing drugs was not effective. Children complain of abdominal pain around the navel spreading to the right iliac fossa, nausea, vomiting 4-5 times with food, clear fluid without blood, mucus and liquid yellow stools 5-6 times/day.

On admission, the child was lethargic, the heart rate was 160 beats/min, the pulse was light, the blood pressure was clamped, the breathing was rapid, the abdomen was slightly distended, the right iliac fossa was painful, and the ultrasound showed congestive appendicitis. Children’s eyes are slightly red, with pink skin on the limbs. The child’s Covid-19 rapid test was negative, but the blood test for nCoV antibodies was positive. While the child had not been vaccinated against Covid-19, doctors determined that the child had been infected with Covid-19 and had recovered.

Blood tests showed a sharp increase in inflammatory response, doctors diagnosed the child with multi-system inflammatory syndrome related to Covid-19, the risk of shock. Immediately, the patient was prescribed anti-shock fluids, early use of vasopressors, high-dose corticosteroids, anticoagulants, broad-spectrum antibiotics, and respiratory support. In addition, doctors performed abdominal CT scan to rule out acute appendicitis, thus, avoiding unnecessary surgery. Pediatric patients also received supportive treatment to correct electrolyte disturbances, acid-base, blood sugar, antipyretic, and nutrition.

The patient is being treated at the City Children’s Hospital. Photo: provided by the doctor

After more than a week of treatment, the child’s condition improved gradually, no fever, no abdominal pain, stable blood pressure, no need to breathe oxygen, eat well. According to Dr. Tien, this is a case of multisystem inflammatory syndrome in children with manifestations similar to acute appendicitis, which, if not diagnosed correctly, can easily lead to unnecessary surgical management.

Multisystem inflammatory syndrome can be seen in children 2-6 weeks after recovering from Covid-19. At this time, the child may have a high fever, abdominal pain, diarrhea, red skin, red tongue, slightly swollen fingers and feet, erythema, heart palpitations, coronary arteries may dilate. This is a characteristic syndrome only in children, not yet recorded in adults. This syndrome is recognized by the Ministry of Health as one of the 5 severe complications of Covid-19 in children. If not detected and treated in time, the child may have hypotension or shock, impaired cardiac function, pericarditis, pericarditis, coronary artery abnormalities, coagulation disorders, acute digestive disorders. calculate…

The doctor also advised parents, when seeing a child with a high fever for more than two days, skin rashes, red eyes, abdominal pain, diarrhea, vomiting, etc., take the child to a medical facility that specializes in paediatrics. The doctor examines, tests accurately, diagnoses the disease accurately, and provides appropriate and timely treatment. In addition to the multisystem inflammatory syndrome as above, children can have measles, rubella, dengue fever, hand, foot and mouth disease, sepsis, appendicitis…

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