Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, United States of America.
Division of Pulmonary and Critical Care, Maimonides Medical Center, Brooklyn, NY, United States of America.
Am J Emerg Med. 2021 Jan;39:253.e1-253.e2. doi: 10.1016/j.ajem.2020.06.053. Epub 2020 Jun 25.
Recent reports have described a secondary Multisystem Inflammatory Syndrome in Children (MIS-C) after a prior COVID-19 infection that often has features of Kawasaki disease (KD). Here, we report the case of a 36-year-old woman who presented to the emergency department hypotensive and tachycardic after 1 week of fevers, abdominal pain, vomiting and diarrhea, and was found to have the classic phenotype of complete Kawasaki's Disease including nonexudative conjunctivitis, cracked lips, edema of the hands and feet, palmar erythema, a diffuse maculopapular rash, and cervical lymphadenopathy. Initial laboratory studies were significant for hyponatremia, elevated liver function tests including direct hyperbilirubinemia, and leukocytosis with neutrophilia. Imaging revealed mild gallbladder wall edema, a small area of colitis, and small pleural effusion. She was treated for Kawasaki Disease Shock Syndrome (KDSS) with pulse dose solumedrol, IVIG, and aspirin with near resolution of symptoms and normalization of vital signs within 1 day and subsequent improvement in her laboratory abnormalities. She was later found to be COVID-19 IgG positive, suggesting past exposure. This case represents an early report of a KD-like illness in an adult with serologic evidence of a previous COVID-19 infection, similar to MIS-C. It suggests that the virulent strain of SARS-CoV-2 appears to cause a post-infectious inflammatory syndrome similar to KD in adults, as well as children. Our understanding of the myriad of COVID-19 symptoms and sequelae is rapidly evolving. We recommend physicians remain vigilant for inflammatory syndromes that mimic KD/KDSS which may warrant prompt treatment with IVIG and steroids.
最近的报告描述了 COVID-19 感染后继发的多系统炎症综合征儿童(MIS-C),其常具有川崎病(KD)的特征。在此,我们报告了 1 例 36 岁女性病例,她在发热、腹痛、呕吐和腹泻 1 周后因低血压和心动过速就诊于急诊,被发现具有完全川崎病的典型表型,包括非渗出性结膜炎、唇裂、手足水肿、手掌红斑、弥漫性斑丘疹和颈部淋巴结肿大。初始实验室研究显示低钠血症、肝功能检查包括直接高胆红素血症显著升高、白细胞增多伴中性粒细胞增多。影像学显示轻度胆囊壁水肿、小面积结肠炎和少量胸腔积液。她因川崎病休克综合征(KDSS)接受了脉冲剂量甲泼尼龙、IVIG 和阿司匹林治疗,症状几乎在 1 天内得到缓解,生命体征恢复正常,随后实验室异常得到改善。随后发现她 COVID-19 IgG 阳性,提示既往感染。该病例代表了成人中以 COVID-19 感染血清学证据为特征的类似 KD 疾病的早期报告,提示 SARS-CoV-2 的毒力株似乎会导致成人和儿童类似 KD 的感染后炎症综合征。我们对 COVID-19 症状和后遗症的认识正在迅速发展。我们建议医生保持警惕,注意可能需要立即使用 IVIG 和类固醇治疗的类似 KD/KDSS 的炎症综合征。