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An adult with Kawasaki-like multisystem inflammatory syndrome associated with COVID-19
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An adult with Kawasaki-like multisystem inflammatory syndrome associated with COVID-19
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Journal Article
An adult with Kawasaki-like multisystem inflammatory syndrome associated with COVID-19
2020
Overview
A recent surge in this disease has prompted health advisories by the US Centers for Disease Control and Prevention (CDC),1 the Royal College of Paediatrics and Child Health,2 and WHO.3 As SARS-CoV-2 spreads and awareness of MIS-C grows, the number of reported cases continues to increase. Complete blood counts showed leukocytosis (11 600–16 500 white blood cells per μL), with lymphopenia (0–700 lymphocytes per μL), neutrophilia (10 100–15 000 neutrophils per μL), atypical lymphocytosis (2% atypical lymphocytes), and increased band neutrophils (2–16% band cells), whereas comprehensive metabolic panels showed hyponatraemia (serum sodium 124–135 mmol/L) and elevated hepatic enzymes (aspartate aminotransferase [AST] 96–198 U/L; alanine aminotransferase 78–133 U/L). Emerging reports have revealed a pattern of clinical differences distinguishing MIS-C from classic Kawasaki disease.5–9 Notably, although our patient's presentation met AHA criteria for Kawasaki disease, he also exhibited many MIS-C-related features such as a predominance of gastrointestinal symptoms, generalised extremity pain, and prominent cardiac dysfunction, and his cardiac findings (elevated cardiac enzymes and left ventricular hypokinesis with a reduction in ejection fraction) resemble findings of myocarditis recently described in MIS-C.10 Furthermore, our patient's palmar lesions are distinct from the acral erythema and swelling with subsequent desquamation typically seen in Kawasaki disease, and his diffuse conjunctivitis was not limbic-sparing.
Publisher
Elsevier Ltd,Elsevier Limited
Subject
/ Biopsy
/ Coronavirus Infections - complications
/ COVID-19
/ Edema
/ Enzymes
/ Erythema
/ Fever
/ Humans
/ Male
/ Mucocutaneous lymph node syndrome
/ Mucocutaneous Lymph Node Syndrome - etiology
/ Multisystem inflammatory syndrome in children
/ Pneumonia, Viral - complications
/ Severe acute respiratory syndrome coronavirus 2
/ Systemic Inflammatory Response Syndrome - etiology
/ Tubes
