{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T08:54:26Z","timestamp":1768899266779,"version":"3.49.0"},"reference-count":8,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T00:00:00Z","timestamp":1704240000000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,12,16]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>We report a case of multisystem inflammatory syndrome in children (MIS-C) in an East Asian toddler. He presented with a 2-day history of fever and pyuria, 5\u2009weeks before that he had recovered from COVID-19. He was initially treated as urinary tract infection. On day 5 of fever, he was noted to have bilateral non-suppurative limbus-sparing conjunctivitis, red and cracked lips and erythematous extremities. Investigations showed raised inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), thrombocytopenia and a markedly elevated NT-proBNP. He received prompt and appropriate treatment inpatient; however, he still had mild coronary abnormalities at 9 months postdischarge. The aim of this paper is to describe the initial presentation and progress of a case of MIS-C. The unique features of this case are his initial presentation of pyuria and notably, his demography (young age, East Asian) which is more typical of Kawasaki disease than MIS-C.<\/jats:p>","DOI":"10.1136\/bcr-2022-253756","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T00:18:01Z","timestamp":1704845881000},"page":"e253756","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Multisystem inflammatory syndrome in children (MIS-C) of a toddler initially presenting with fever and pyuria"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7411-3492","authenticated-orcid":false,"given":"Kinyui Alice","family":"Lo","sequence":"first","affiliation":[{"name":"Department of Family Medicine, National University Health System, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lee Gan","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, National University Health System, Singapore"},{"name":"Department of Medicine, National University Health System, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajeev","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"Khoo Teck Puat\u2013National University Children\u2019s Medical Institute, National University Health System, Singapore"},{"name":"Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,1,3]]},"reference":[{"key":"2025082712221040000_17.1.e253756.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31094-1"},{"key":"2025082712221040000_17.1.e253756.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2021680"},{"key":"2025082712221040000_17.1.e253756.3","unstructured":"MOH media statement on Paediatric MIS-C cases in Singapore. 2021. Available: https:\/\/www.moh.gov.sg\/news-highlights\/details\/media-statement-on-paediatric-mis-c-cases-in-singapore"},{"key":"2025082712221040000_17.1.e253756.4","unstructured":"Centers for disease control and prevention. 2020. Available: https:\/\/www.cdc.gov\/mis\/mis-c\/hcp\/index.html"},{"key":"2025082712221040000_17.1.e253756.5","doi-asserted-by":"crossref","first-page":"115","DOI":"10.47102\/annals-acadmedsg.2021426","article-title":"The evolution of severity of paediatric COVID-19 in Singapore: verticaltransmission and multisystem inflammatory syndrome in children","volume":"51","author":"Leow","year":"2022","journal-title":"Ann Acad Med Singap"},{"key":"2025082712221040000_17.1.e253756.6","first-page":"76","article-title":"Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2: a case report","volume":"28","author":"Chua","year":"2022","journal-title":"Hong Kong Med J"},{"key":"2025082712221040000_17.1.e253756.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.mehy.2020.110263"},{"key":"2025082712221040000_17.1.e253756.8","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-021-00709-9"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-253756","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:22:17Z","timestamp":1756322537000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-253756"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,3]]},"published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1136\/bcr-2022-253756"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-253756","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]}}}