Page 253 - Abstract Book KONIKA 18

Infection & Tropical Disease

P-ITD-001
Multisystem Inflammatory Syndrome in A Child Following COVID-19 Infection:
A Case Report

Amar W. Adisasmito, Dina Garniasih, Anna Tjandrajani, Pustika Efar
Department of Child Health, Harapan Kita Women and Children Hospital, Jakarta, Indonesia

Abstract
Background Multisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV2
infection was found to occur weeks/months after infection. This is potentially a life-threatening condition
which is difficult to be recognized by many pediatricians. Objective To present a clinical presentation of MIS-C
following COVID-19 infection. Case We reported a case of 16-month-old girl, presented with 2-months of
prolonged fever, painful-rash around waist, anemia, malnutrition. Past history revealed multiple surgeries
related to atresia-ani. Last surgery: directly followed by SARS-CoV2-infection. This was 4-months prior to
this admission. There was multiple lymphadenopathy in inguinal and neck region. Abdominal-ultrasound
showed mesenterial-adenitis. Chest-x-ray was normal. Tuberculine skin-test was negative; sputum was
negative for tuberculosis but IGRA was indeterminate. Patient had increased WBC (75.000/UL), ferritin
(15.000ng/mL) and LDH (2810U/L); hypoalbuminemia; high-ALT; and electrolyte-imbalance. She had
hypercoagulopathy (d-dimer7011mg/mL) but no treatment because of late result. Cytokines were not
examined. Blood-cultures came back negative. Echocardiography revealed mild dilation on right ventricle/
tricuspid regurgitation. Differential-diagnosis in this patient were: 1.Malignancy, 2.Tuberculosis, 3.MIS-C.
She received Ceftriaxone-IV followed by AmpicillinSulbactam-IV. Malignancy was first suspected; however,
bone-marrow immunophenotyping revealed myelocyte-promyelocyte dominance and lymph-node biopsy
showed reactive lesion in non-neoplastic disease. Then she had history of tonic-clonic seizure, menigitis
tuberculosis was suspected. She was treated with antituberculosis-regimen with dexamethasone but there
was no improvement. Her conditions worsened and she was intubated. She passed away due to repeated
bradycardia and desaturation episodes. Conclusion A more severe spectrum of MIS-C following COVID-19
infection presented with multiorgan involvement which may increase morbidity and mortality.

Keywords: COVID-19; multiple-inflammatory-syndrome/MIS-C; multiorgan involvement

P-ITD-002
Early Recognition of Multiple Abdominal Involvement of Tuberculosis
in Pediatric Patient with Pulmonary Tuberculosis in Limited Care Facility:
A Case Report

1
2
Muhammad Hadley Aulia , Asterisa Retno Putri , Runi Arumndari 2
Harapan Bunda Hospital, Central Lampung Regency, Lampung and Brawijaya Women and Children Hospital,
1
Jakarta , Indonesia
2
Abstract
Background Tuberculosis is one of the leading causes of death from an infectious disease worldwide.
World Health Organization (WHO) estimates that annually, 1 million children have TB disease and many
complications can ensue. The global burden of tuberculosis could be altered by different factors, one of which
is low access of populations in low-resource settings to both diagnosis tests and effective medical treatment.
Objective To recognize the importance of early signs of serious abdominal involvement of TB especially
in limited care facility. Case A 7-year-old boy, weighed 13 kg, came to our hospital with abdominal pain,
distention, fever, and palpated lymph nodes. Chest radiograph PA/lateral showed extensive infiltrate. Patient
had a history of cough for more than a month, daily fever of unknown origin for 2 weeks, and anorexia.
Patient was referred with emergent case of suspected peritonitis TB. Patient admitted to our hospital 2 months
later with jaundice since 3 days before admission. From previous peritonitis, exploratory laparotomy was
performed and stoma was created. Patient was already on anti-tuberculosis drugs (rifampicin, isoniazid,
pyrazinamide). Laboratory results showed SGOT 62 U/L, SGPT 71 U/L, total bilirubin 16.6 mg/dL, direct
bilirubin 10.6 mg/dl, indirect bilirubin 6.0 mg/dL. Abdominal ultrasonography showed cholestasis. Patient
was referred again to a referral hospital. Conclusion It is important to recognize early signs of serious
abdominal involvement of TB in limited care facility because the diagnosis is often difficult, unsuspected,
often delayed, and frequently presenting with nonspecific and insidious symptoms.
Keywords: tuberculosis; limited care facility; abdominal TB

KONIKA XVIII Abstract Book 205