A rare case of unusual anti-tuberculosis drug reaction in disseminated tuberculosis with pre-existing Multisystem Inflammatory Syndrome in Children (MIS-C)

Children with Multisystem Inflammatory Syndrome in Children (MIS-C) often have weakened immune systems and more prone to secondary infections such as tuberculosis (TB). MIS-C is a rare case but serious complication of COVID-19. It commonly affects the gastrointestinal, cardiovascular, hematologic, and mucocutaneous systems. This study presents a case of MIS-C in a 15-year-old girl complicated by respiratory failure, increased intracranial pressure with status epilepticus, grade II TB meningitis, severe dengue, disseminated TB, anti-tuberculosis drug induced hepatotoxicity, and cutaneous drug eruption. The patient had a history of prior COVID-19 infections and arrived the emergency department with high fever, loss of consciousness, seizure, a generalized maculopapular rash, and respiratory failure. Laboratory results showed significantly elevated liver enzyme, while chest X-ray confirmed pleural effusion and pulmonary TB. A multidisciplinary team was formed, including specialists in respirology, cardiology, pediatric neurology, immunology, and gastro-hepatology division. The patient received high dose of steroid, anti-tuberculosis regiment, and phenobarbital to control the seizure. N-acetylcysteine and enoxaparin were administered as a part of the MIS-C treatment protocol. The patient was discharged after three weeks of intensive care but required monthly readmission due to recurrent complications. This study suggests the importance of early detection and comprehensive management of MIS-C to reduce the risk of mortality and secondary infection in long-term impact of the syndrome.