{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T10:59:33Z","timestamp":1771671573956,"version":"3.50.1"},"reference-count":27,"publisher":"FapUNIFESP (SciELO)","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Col. Bras. Cir."],"abstract":"<jats:p>ABSTRACT  Introduction:  the new coronavirus pandemic has been a reality throughout 2020, and it has brought great challenges. The virus predominantly manifests in the pediatric population with mild symptoms. However, an increase in the incidence of Multisystemic Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 has been described in the literature. MIS-C manifests mainly with fever and gastrointestinal symptoms and may mimic acute abdomen due to acute appendicitis. The objective of this study is to propose a care flowchart for suspected cases of acute appendicitis in the initial phase in pandemic times, considering the possibility of MIS-C. This situation was brought up by a patient treated in a pediatric hospital in Brazil.  Discussion:  It was possible to identify common signs and symptoms in the reported patient and those published cases that may serve as alerts for early identification of MIS-C cases. Based on the literature review and on the similarities between the syndrome and the inflammatory acute abdomen in children, we elaborated an initial approach for these cases to facilitate the identification, early diagnosis, and management. The flowchart considers details of the clinical history, physical examination, and complementary exams prior to the indication of appendectomy in patients with initial phase symptoms.  Conclusion:  MIS-C, although rare and of poorly known pathophysiology, is most often severe and has a high mortality risk. The use of the proposed flowchart can help in the diagnosis and early treatment of MIS-C.<\/jats:p>","DOI":"10.1590\/0100-6991e-20213012","type":"journal-article","created":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T12:28:20Z","timestamp":1641385700000},"source":"Crossref","is-referenced-by-count":2,"title":["COVID-19 associated multisystem inflammatory syndrome in children mimicking acute appendicitis - how to differentiate and conduct pediatric patients during the pandemic? - Proposal of a management flowchart"],"prefix":"10.1590","volume":"48","author":[{"given":"LORAINE ENTRINGER","family":"FALQUETO","sequence":"first","affiliation":[{"name":"Hospital Pequeno Principe,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CAROLINA MARTINS","family":"VISSOCI","sequence":"additional","affiliation":[{"name":"Hospital Pequeno Principe,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ISABELLA CRISTINA BONETTO","family":"FERREIRA","sequence":"additional","affiliation":[{"name":"Hospital Pequeno Principe,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"AMANDA GINANI","family":"ANTUNES","sequence":"additional","affiliation":[{"name":"Hospital Pequeno Principe,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"FERNANDO ANT\u00d4NIO BERSANI","family":"AMADO","sequence":"additional","affiliation":[{"name":"Hospital Pequeno Principe,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"SYLVIO ANDRADE GILBERTO","family":"AVILLA","sequence":"additional","affiliation":[{"name":"Hospital Pequeno Principe,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"CLAUDIO","family":"SCHULZ","sequence":"additional","affiliation":[{"name":"Hospital Pequeno Principe,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"FABIO ARAUJO","family":"MOTTA","sequence":"additional","affiliation":[{"name":"Hospital Pequeno Principe,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8642-3562","authenticated-orcid":false,"given":"ELISANGELA DE MATTOS E","family":"SILVA","sequence":"additional","affiliation":[{"name":"Hospital Pequeno Principe,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2021]]},"reference":[{"issue":"10237","key":"ref1","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1016\/S0140-6736(20)31094-1","article-title":"Hyperinflammatory shock in children during COVID-19 pandemic","volume":"395","author":"Riphagen S","year":"2020","journal-title":"Lancet"},{"key":"ref2","series-title":"PICS Statement: Increased number of reported cases of novel presentation of multi-system inflammatory disease","year":"2020"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.1136\/bmj.m2123","article-title":"Pediatric inflammatory syndrome temporally related to covid-19","volume":"369","author":"Son MB","year":"2020","journal-title":"BMJ"},{"key":"ref4","series-title":"Rapid risk assessment: Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children","author":"Albiger A","year":"2020"},{"key":"ref5","series-title":"Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19","author":"Bahl R","year":"2020"},{"issue":"2","key":"ref6","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2020-1711","article-title":"SARS-CoV-2-Induced Kawasaki-Like Hyperinflammatory Syndrome A Novel COVID Phenotype in Children","volume":"146","author":"Licciardi F","year":"2020","journal-title":"Pediatrics"},{"issue":"10239","key":"ref7","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1016\/S0140-6736(20)31103-X","article-title":"An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic an observational cohort study","volume":"395","author":"Verdoni L","year":"2020","journal-title":"Lancet,"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1001\/jama.2020.10369","article-title":"Clinical Characteristics of 58 Children with a Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2","volume":"324","author":"Whittaker E","year":"2020","journal-title":"JAMA"},{"issue":"4","key":"ref9","article-title":"Anti-spike IgG causes severe acute lung injury by skewing macrophage responses during acute SARS-CoV infection","volume":"4","author":"Liu L","year":"2019","journal-title":"JCI Insight"},{"issue":"4","key":"ref10","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1056\/NEJMoa2021680","article-title":"Multisystem inflammatory syndrome in U S. 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