Recognizing a MIS-Chievous Cause of Acute Viral Gastroenteritis

Rohit Josyabhatla; Ankur A Kamdar; Shabba A Armbrister; Rhea Daniel; Konstantinos Boukas; Keely G Smith; Melissa R Van Arsdall; Kokila Kakarala; Anthony R Flores; Audrey Wanger; Yuying Liu; Jon Marc Rhoads

doi:10.3389/fped.2021.748368

Recognizing a MIS-Chievous Cause of Acute Viral Gastroenteritis

Front Pediatr. 2021 Oct 29:9:748368. doi: 10.3389/fped.2021.748368. eCollection 2021.

Authors

Rohit Josyabhatla^{1

2}, Ankur A Kamdar^{2

3}, Shabba A Armbrister¹, Rhea Daniel^{1

2}, Konstantinos Boukas^{2

4}, Keely G Smith^{2

5}, Melissa R Van Arsdall^{1

2}, Kokila Kakarala^{2

5}, Anthony R Flores^{2

6}, Audrey Wanger⁷, Yuying Liu¹, Jon Marc Rhoads^{1

2}

Affiliations

¹ Division of Gastroenterology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.
² Children's Memorial Hermann Hospital, Houston, TX, United States.
³ Division of Rheumatology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.
⁴ Division of Critical Care Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.
⁵ Division of Pediatric Hospital Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.
⁶ Division of Infectious Disease, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.
⁷ Department of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.

Abstract

Historically, children evaluated for vomiting and diarrhea secondary to viral enteritis have symptoms lasting 2-4 days and respond to supportive care, including oral rehydration and anti-emetics if required. Recently, within a 14-day timespan, we encountered three children with severe diarrhea who rapidly became dehydrated and went into hypotensive shock. Although SARS-CoV-2 molecular tests were negative by nasopharyngeal swab, all were later found to have MIS-C. This small case series underscores features reported in previous larger studies and emphasizes the rapid clinical evolution of this condition. We highlight the importance of early recognition of cardinal laboratory findings characteristic of MIS-C (i.e., lymphopenia, markedly elevated acute phase reactants, and hypoalbuminemia). We also show serologic evidence that the pathophysiological mechanism of SARS-CoV-2 related diarrhea may differ from other causes of dehydrating vomiting and diarrhea, with no serologic evidence of villus cell injury.

Keywords: I-FABP2; MIS-C multisystem inflammatory syndrome in children; claudin-3; diarrhea; zonulin.