Initial reports from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic described children as being less susceptible to coronavirus disease (COVID-19) than adults. Later on, a severe and novel pediatric disorder termed multisystem inflammatory syndrome in children (MIS-C) emerged. Pediatric patients with SARS-CoV-2 are at risk for critical illness with severe pulmonary COVID-19 and MIS-C. Both are described as two distinct conditions, and the differentiation between them was the scope of many studies. In this report from Egypt, we will describe two unique pediatric cases presented by combined manifestations of severe pulmonary COVID-19 and MIS-C. Two patients presented with severe pulmonary COVID-19 evident by pulmonary symptoms, signs, and advanced CO-RADS stage in lung CT were simultaneously fulfilling the clinical criteria of MIS-C including fever, multi-system affection, increased inflammatory markers in addition to the proved COVID-19 by positive serologic tests for SARS-CoV-2 but PCR was negative. Both patients responded well to immune-modulation therapy by IVIG and steroids and discharged well under closed follow-up. Although it is debatable to present simultaneously, MIS-C should be considered in patients presenting with typical clinical findings and concerns for pulmonary COVID-19 once the criteria for MIS-C diagnosis is fulfilled. Starting treatment without delay can favor better prognosis.

中文翻译：

---

儿童重症肺部 COVID-19 和多系统炎症综合征 (MIS-C) 的合并表现：两例埃及儿科病例报告

严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 大流行的初步报告称，儿童对冠状病毒病 (COVID-19) 的易感性低于成人。后来，出现了一种称为儿童多系统炎症综合征 (MIS-C) 的严重的新型儿科疾病。患有 SARS-CoV-2 的儿科患者有患严重肺部 COVID-19 和 MIS-C 的危重疾病的风险。两者都被描述为两种不同的条件，它们之间的区别是许多研究的范围。在这份来自埃及的报告中，我们将描述两个独特的儿科病例，这些病例由严重的肺部 COVID-19 和 MIS-C 的联合表现呈现。两名患者出现严重的肺部 COVID-19，肺部症状、体征、肺 CT 中的 CO-RADS 和晚期 CO-RADS 分期同时满足 MIS-C 的临床标准，包括发热、多系统感染、炎症标志物增加以及通过 SARS-CoV-2 阳性血清学检测但 PCR 证实的 COVID-19是消极的。两名患者对 IVIG 和类固醇的免疫调节治疗反应良好，并在密切随访下出院。尽管同时就诊是有争议的，但一旦满足 MIS-C 诊断标准，就应考虑在出现典型临床表现和肺部 COVID-19 担忧的患者中考虑 MIS-C。立即开始治疗有利于更好的预后。两名患者对 IVIG 和类固醇的免疫调节治疗反应良好，并在密切随访下出院。尽管同时就诊是有争议的，但一旦满足 MIS-C 诊断标准，就应考虑在出现典型临床表现和肺部 COVID-19 担忧的患者中考虑 MIS-C。立即开始治疗有利于更好的预后。两名患者对 IVIG 和类固醇的免疫调节治疗反应良好，并在密切随访下出院。尽管同时就诊是有争议的，但一旦满足 MIS-C 诊断标准，就应考虑在出现典型临床表现和肺部 COVID-19 担忧的患者中考虑 MIS-C。立即开始治疗有利于更好的预后。