Multisystem inflammatory syndrome following COVID-19 infection mimicking abdominal tuberculosis in Nepal: A case report.

Introduction and importance: Multisystem Inflammatory Syndrome in Children (MIS-C) is an uncommon condition that can present with a wide range of clinical features and complications. As it can be confused with various diseases, diagnosis is crucial as proper management can improve the patient's condition. Case presentation: 14-year male presented with fever, abdominal pain, and cough on September 2021. On examination, he was febrile with a distended abdomen and enlarged liver. Following investigations, abdominal tuberculosis was suspected but his condition improved with broad-spectrum antibiotics, intravenous immunoglobulins, and high-dose steroids. Clinical discussion: Any children with COVID 19 infection who have fever with multiple systems involved after ruling out other causes of infections should be suspected to have MIS-C. Diagnosis can be challenging as its clinical presentation mimics conditions like Kawasaki disease, ricketssial disease and acute appendicitis, etc. In high prevalence countries, with predominant gastrointestinal features, it can be confused with abdominal tuberculosis as well, hence, proper diagnosis is crucial. Conclusion: The course of MIS-C can be fatal where most children require intensive care units and early institution of immunomodulatory therapy for their recovery. Also, all pediatricians need to have a high degree of suspicion to diagnose MIS-C as it can be confused with different illnesses.