Razavi Alexander C, Chang Jonathan L, Sutherland Aimee, Niyogi Anjali, Ménard Geraldine E
Tulane University, New Orleans, LA, USA.
J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620974200. doi: 10.1177/2324709620974200.
We present the case of a young obese patient with recent COVID-19 (coronavirus disease 2019) who developed multisystem inflammatory syndrome (MIS) 1 month after spontaneous resolution. A 23-year-old African American man was admitted with a 1-week history of worsening fatigue, myalgias, headache, and dyspnea. Nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative by polymerase chain reaction; however, the patient was febrile and had leukocytosis, elevated troponin I, transaminitis, and acute kidney injury. Bedside echocardiogram showed decreased left ventricular ejection fraction (40% to 45%) and global hypokinesis in the setting of a type II non-ST segment myocardial infarction. Despite being on broad spectrum antibiotic therapy, the patient's clinical condition continued to worsen. The patient was then empirically treated for MIS with intravenous immunoglobulin and methylprednisolone, which led to a rapid resolution of fever and laboratory abnormalities. This case highlights that MIS associated with COVID-19 may present in patients above the age of 21 years and can occur with a delayed onset after mild illness in those with no previous oxygen requirement or hospitalization during SARS-CoV-2 infection.
我们报告了一例年轻肥胖的新冠肺炎（2019冠状病毒病）患者，在自发康复1个月后出现多系统炎症综合征（MIS）。一名23岁的非裔美国男性因疲劳、肌痛、头痛和呼吸困难加重1周入院。严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的鼻咽拭子聚合酶链反应检测呈阴性；然而，患者发热，有白细胞增多、肌钙蛋白I升高、转氨酶升高和急性肾损伤。床旁超声心动图显示在II型非ST段心肌梗死情况下左心室射血分数降低（40%至45%）和整体运动减弱。尽管接受了广谱抗生素治疗，患者的临床状况仍继续恶化。然后该患者接受了静脉注射免疫球蛋白和甲基泼尼松龙的经验性治疗，这导致发热和实验室异常迅速缓解。该病例突出表明，与新冠肺炎相关的MIS可能出现在21岁以上的患者中，并且在SARS-CoV-2感染期间以前不需要吸氧或住院的轻症患者中可能会在疾病轻度发作后延迟出现。
