spectrum of post covid-19 manifestations in children: a case series

Background: multisystem inflammatory syndrome in children (mis-c) is a common diagnosis among children in the post covid-19 era, which usually presents with fever and varied systemic manifestations. bcg vaccination site reaction as a manifestation of mis-c is barely ever documented. in this series, we present a rare such case report along with the other six other cases.case presentations: seven cases with mis-c are presented with four male and three female children. the median age of presentation was 3 (range: 0.4-14) years. fever was the most common (100%) symptom followed by muco-cutaneous manifestation (50%, 4/7), as well as gastrointestinal (37.5%, 3/7), and cardiovascular symptoms (37.5%, 3/7). the clinical features which led to the diagnosis include bcg site vaccination, erythema multiforme, periungual and perineal peeling, unilateral knee joint effusion, skin scalding syndrome, urticaria, and acute glomerulonephritis. the initial work-up for fever did not yield any cause, except for a non-specific elevation of inflammatory markers. 6 cases had elevated anti-sars-co-v2 antibody titres with a negative rtpcr/rat test and 1 case yielded positive rtpcr for covid status for acute infection. 2d echocardiography showed coronary artery dilatation in two patients which resolved on follow-up. all the patients responded well to intravenous immunoglobulin and methylprednisolone combination therapy with antiplatelet drugs.conclusion: bcg vaccination site reaction could occur due to antigen-homology. cardiovascular manifestations (coronary artery dilatation) without hemodynamic instability may also be a manifestation of mis-c, thereby placing 2d-echo as an important step in diagnostic workup.