Nelson Cole, Ishimine Paul, Hayden Stephen R, Correia Matthew, Wardi Gabriel
Department of Emergency Medicine, University of California at San Diego, San Diego, California.
Department of Emergency Medicine, University of California at San Diego, San Diego, California; Division of Emergency Medicine, Rady Children's Hospital, San Diego, California.
J Emerg Med. 2020 Nov;59(5):699-704. doi: 10.1016/j.jemermed.2020.09.008. Epub 2020 Oct 1.
A small subset of pediatric patients develop a rare syndrome associated with Coronavirus Disease 2019 (COVID-19) infection called multisystem inflammatory syndrome in children (MIS-C). This syndrome shares characteristics with Kawasaki disease.
A 15-year-old girl presented to our Emergency Department (ED) with fevers and malaise. She was diagnosed on her initial visit with an acute viral syndrome and discharged with a COVID polymerase chain reaction test pending, which was subsequently negative. She returned 3 days later with persistent fever, conjunctivitis, and a symmetric targetoid rash over her palms. She had no adenopathy, but her erythrocyte sedimentation rate and C-reactive protein were both significantly elevated at 90 mm/h and 19.61 mg/dL, respectively. The patient was then transferred to the regional children's hospital due to a clinical suspicion for MIS-C, and subsequent COVID-19 immunoglobulin G testing was positive. She had been empirically started on intravenous immunoglobulin in addition to 81 mg aspirin daily. Initial echocardiograms showed mild dilatation of the left main coronary artery, and on repeat echocardiogram, a right coronary artery aneurysm was also identified. Oral prednisone therapy (5 mg) was initiated and the patient was discharged on a continued prednisone taper. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We present a case of a 15-year-old girl who presented to the ED with MIS-C who developed coronary aneurysms despite early therapy, to increase awareness among emergency physicians of this emerging condition.
一小部分儿科患者会患上一种与2019冠状病毒病（COVID-19）感染相关的罕见综合征，称为儿童多系统炎症综合征（MIS-C）。该综合征与川崎病有共同特征。
一名15岁女孩因发热和不适就诊于我们的急诊科。她初诊时被诊断为急性病毒综合征，在等待COVID聚合酶链反应检测结果期间出院，检测结果随后为阴性。3天后她因持续发热、结膜炎和手掌出现对称性靶形皮疹再次就诊。她没有淋巴结肿大，但红细胞沉降率和C反应蛋白均显著升高，分别为90mm/h和19.61mg/dL。由于临床怀疑为MIS-C，该患者随后被转至地区儿童医院，随后COVID-19免疫球蛋白G检测呈阳性。除每天服用81mg阿司匹林外，她还经验性地开始接受静脉注射免疫球蛋白治疗。最初的超声心动图显示左主冠状动脉轻度扩张，再次超声心动图检查时，还发现了右冠状动脉瘤。开始口服泼尼松治疗（5mg），患者出院时继续逐渐减量服用泼尼松。急诊科医生为何应了解此情况？：我们报告了一例15岁女孩因MIS-C就诊于急诊科的病例，尽管早期进行了治疗，但仍出现了冠状动脉瘤，以提高急诊科医生对这种新出现疾病的认识。
