<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-1249</journal-id>
<journal-title><![CDATA[Archivos de Pediatría del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Arch. Pediatr. Urug.]]></abbrev-journal-title>
<issn>1688-1249</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Uruguaya de Pediatría]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-12492022000301313</article-id>
<article-id pub-id-type="doi">10.31134/ap.93.s1.14</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Síndrome multisistémico post COVID-19 y dificultad en su diagnóstico etiológico. A propósito de un caso clínico]]></article-title>
<article-title xml:lang="en"><![CDATA[Multisystem post COVID-19 syndrome and its difficult etiological diagnosis. A clinical case]]></article-title>
<article-title xml:lang="pt"><![CDATA[Síndrome multissistêmica pós COVID-19 e a dificuldade no seu diagnóstico etiologico. Relato de caso clínico]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martínez]]></surname>
<given-names><![CDATA[Natalia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Venturino]]></surname>
<given-names><![CDATA[Claudia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gibara]]></surname>
<given-names><![CDATA[Silvia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mata]]></surname>
<given-names><![CDATA[Adriana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cabrera]]></surname>
<given-names><![CDATA[Gonzalo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Finozzi]]></surname>
<given-names><![CDATA[Alejandro]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[SanMartín]]></surname>
<given-names><![CDATA[Rosario]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Chiparelli]]></surname>
<given-names><![CDATA[Héctor]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Flieller]]></surname>
<given-names><![CDATA[María Rosa]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Machado]]></surname>
<given-names><![CDATA[Karina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Badia]]></surname>
<given-names><![CDATA[Federica]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pírez]]></surname>
<given-names><![CDATA[Catalina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,CHPR Clínica Pediátrica A ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af2">
<institution><![CDATA[,COMEPA Servicio Pediatría ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af3">
<institution><![CDATA[,COMEPA Servicio Pediatría ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af4">
<institution><![CDATA[,COMEPA Servicio Pediatría ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af5">
<institution><![CDATA[,MSP Depto. Laboratorio Salud Pública ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af6">
<institution><![CDATA[,DLSP Unidad Virología ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af7">
<institution><![CDATA[,MSP Depto. Laboratorio Salud Pública ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
</aff>
<aff id="Af8">
<institution><![CDATA[,UDELAR Facultad de Medicina Clínica Pediátrica A]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af9">
<institution><![CDATA[,UDELAR Facultad de Medicina Clínica Pediátrica A]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="A10">
<institution><![CDATA[,UDELAR Facultad de Medicina Clínica Pediátrica A]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2022</year>
</pub-date>
<volume>93</volume>
<numero>nspe1</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-12492022000301313&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-12492022000301313&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-12492022000301313&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: El SARS-CoV-2 afecta a un reducido número de pacientes pediátricos, que en su mayoría son asintomáticos o presentan compromiso respiratorio leve y evolución favorable. Sin embargo, en niños previamente sanos puede aparecer el síndrome inflamatorio multisistémico (SIM-C) o similar a Kawasaki (Kawasaki-like) asociado a la enfermedad por COVID-19, que evolucionan al shock y requiere internación en la unidad de cuidados intensivo. Presentamos el caso de un adolescente con antecedentes ambientales de SARS-CoV-2 37 días antes de su ingreso, que no se testeó en ese momento. Recibe la primera dosis de vacuna Pfizer 15 días antes de la presentación de un cuadro de sintomatología digestiva con dolor abdominal y fiebre, con test de antígenos COVID-19 y PCR viral negativos. Luego de una laparoscopia exploratoria, al sexto día de fiebre y dolor instaló conjuntivitis bilateral no supurada y exantema en tórax, odinofagia, astenia y lengua saburral con fenotipo Kawasaki. La serológica IgG anti spike fue positiva y la IgM negativa, con parámetros inflamatorios elevados, por lo que se planteó un síndrome multisistémico post COVID-19. Recibió tratamiento con inmunoglobulina intravenosa, ácido acetilsalicílico y metilprednisolona. Dada la necesidad de descartar la posibilidad de un evento atribuible a vacunación o inmunización (ESAVI), se realizó la búsqueda serológica para SARS-CoV-2, en un estudio cualitativo, buscando anticuerpos que no se generan con la vacuna Pfizer, que fueron positivos. De esta forma confirmamos la etiología post COVID-19 y descartamos la etiología por ESAVI, realizándose además el estudio cuantitativo de los anticuerpos anti spike con disminución de estos al mes del debut.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Summary: SARS-CoV-2 affects a low number of pediatric patients, most asymptomatic or with mild respiratory compromise and favorable evolution. However, in previously healthy children, Multisystem Inflammatory Syndrome (SIM-C) or Kawasaki-like Syndrome(Kawasaki-like) may appear linked to the COVID-19 disease, progressing to shock and requiring admission to the intensive care unit. We present the case of an adolescent with an environmental history of SARS-CoV-2 37 days prior to her admission, who was not tested at that time. She had received the first dose of Pfizer vaccine 15 days before the presentation of digestive symptoms with abdominal pain and fever. She had a negative Covid-19 antigen test and viral PCR. After an exploratory laparoscopy, on the sixth day of fever and pain, she developed bilateral non-suppurative conjunctivitis and a rash on the chest, odynophagia, asthenia, and coated tongue with the Kawasaki phenotype. The anti-spike IgG serology was positive and the IgM negative, with elevated inflammatory parameters, so a post-COVID-19 multisystem syndrome was suggested. She received treatment with intravenous immunoglobulin, ASA and methylprednisolone. In order to rule out the possibility of an event allegedly caused by vaccination or immunization (ESAVI), the serological search for SARS-CoV-2 was carried out through a qualitative study, looking for antibodies that are not generated with the Pfizer vaccine. The result was positive. Therefore, we confirmed the post-Covid etiology and ruled out the ESAVI etiology, and also performed the quantitative study of the anti-spike antibodies, which showed a decrease one month after the debut.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: O SARS-CoV-2 afeta um número reduzido de pacientes pediátricos, em sua maioria, assintomáticos ou apresentando comprometimento do nível respiratório e evolução favorável. Porém, em crianças previamente sãs, pode aparecer a Síndrome Inflamatória Multissistêmica (SIM-C) ou similar a Kawasaki (Kawasaki-like) associada à doença por COVID-19, que pode evoluir a choque e requer a internação na UTI. Apresentamos o caso de um adolescente com antecedentes ambientais de SARS-CoV-2 37 dias antes do seu ingresso, que não se testou nesse momento. Recebendo a dose da primeira vacina Pfizer 15 dias antes da apresentação de sintomatologia digestiva com dor abdominal e febre. Teve um teste de antígenos COVID-19 viral negativo. Depois de una laparoscopia exploratória, ao sexto dia de febre e dor, teve conjuntivite bilateral não supurada e exantema en tórax, odinofagia, astenia e língua saburral com fenótipo Kawasaki. A sorologia IgG anti-spike foi positiva e a gM negativa, com parâmetros inflamatórios superiores, indicando uma síndrome multissistêmica pós Covid 19. O tratamento recebido foi imunoglobulina intravenosa, AAS e Metilprednisolona. Com o fim de descartar a possibilidade de um evento supostamente atribuível à vacinação ou vacinação positiva (ESAVI), realizou-se uma busca sorológica para SARS COV2, através de um estúdio qualitativo, procurando anticorpos não gerados pela vacina Pfizer, os quais foram confirmados. Nesta forma, confirmamos a etiologia pós-Covid e descartamos a etiologia por ESAVI. Aliás, realizamos um estudo quantitativo dos anticorpos anti-spike e comprovamos a sua diminuição a um mês de ter acontecido o debut.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Síndrome de respuesta inflamatoria sistémica]]></kwd>
<kwd lng="es"><![CDATA[COVID- 19]]></kwd>
<kwd lng="es"><![CDATA[Enfermedad de Kawasaki]]></kwd>
<kwd lng="es"><![CDATA[Niño]]></kwd>
<kwd lng="en"><![CDATA[System inflammatory response syndrome]]></kwd>
<kwd lng="en"><![CDATA[COVID- 19]]></kwd>
<kwd lng="en"><![CDATA[Kawasaki disease]]></kwd>
<kwd lng="en"><![CDATA[Child]]></kwd>
<kwd lng="pt"><![CDATA[Síndrome de resposta inflamatória sistémica]]></kwd>
<kwd lng="pt"><![CDATA[COVID-19]]></kwd>
<kwd lng="pt"><![CDATA[Doença de Kawasaki]]></kwd>
<kwd lng="pt"><![CDATA[Criança]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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