861 PIMS or not? Alternative diagnoses in the febrile child during the COVID-19 pandemic

• Published in: Archives of disease in childhood 2021-10, Vol.106 (Suppl 1), p.A138-A139
• Main Authors: White, Marie, Kennedy, Caroline, Carter, Michael, Shivamurthy, Vinay, Cheung, Ronny, Kenny, Julia, Wong, James, Parish, Emma, Theocharis, Paraskevi, Miller, Owen, Handforth, Jennifer
• Format: Article
• Language: English
• Subjects: Abstracts; Appendicitis; Arthritis; Cell activation; Children; Coronaviruses; COVID-19; Crohn's disease; Diagnosis; Fever; Gastroenteritis; Hospitals; Infections; Inflammatory bowel diseases; Leukemia; Lymphadenitis; Macrophages; Medical diagnosis; Meningitis; Pandemics; Patients; Pediatrics; Phenotypes; Pyelonephritis; Respiratory tract; Respiratory tract diseases; Sepsis; Severe acute respiratory syndrome coronavirus 2; Urinary tract; Vasculitis
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2021-rcpch.241

BackgroundThe majority of children and young people affected by COVID-19 have remained asymptomatic or suffered mild illnesses. However throughout the pandemic patients with a novel rare but severe disease phenotype, Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS)1 continue to need hospital admission. The importance of considering the wider differential such as malignancies should be highlighted.ObjectivesTo establish the range of diagnoses of children admitted to a tertiary London children’s hospital presenting with a history of fever and high CRP, in whom PIMS-TS was considered as a diagnosis, during the COVID-19 pandemic.MethodsClinical records from 1st March 2020 to 30th June 2020 (inclusive) were retrospectively analysed to identify patients under the age of 18 years admitted to a tertiary London children’s hospital with a history of fever and CRP >60. Electronic notes were reviewed to determine final diagnosis.Results140 patients were admitted with a history of fever and CRP >60 during the study period. 58% (n=81) had PIMS-TS and 42% (n=59) had alternative diagnoses. Of those with an alternative diagnosis 81% (n=48) had infective diagnoses and of these 46% (n=22) had upper or lower respiratory tract infections; 25% (n=12) had sepsis; 13% (n=6) had urinary tract infections or pyelonephritis; 10% (n=5) had gastroenteritis; 4% (n=2) had lymphadenitis and 2% (n=1) had meningitis. 10% (n=5) had surgical diagnoses most commonly appendicitis (n=3). 5% (n=3) had inflammatory diagnoses; 2 with an exacerbation of Crohn’s disease and 1 with vasculitis. 3% (n=2) had autoimmune diagnoses, 1 with juvenile idiopathic arthritis and 1 with Still’s disease who developed macrophage activation syndrome. 2% (n=1) had Burkitt leukaemia.ConclusionsIn the midst of a pandemic there is a high suspicion of PIMS-TS in unwell febrile children. The high numbers of patients with PIMS-TS admitted to this hospital reflects the regional referrals pathway for the PIMS-TS patients during the first wave of COVID-19. However infections remain a major cause of children presenting with fever and a high CRP. The range of alternative diagnoses outlined in our cohort is not surprising, when one considers that PIMS-TS is a disease with a subjective and broad case definition, with signs and symptoms overlapping with other serious diagnoses – infectious, surgical, inflammatory, autoimmune and malignant.The wider differential diagnoses should always be