Khokhar Farzam, Bhura Zainab, Muneeb Muhammad, Singh Garima, Yu Jianghong
Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA.
Internal Medicine, University Health Network, Toronto, CAN.
Cureus. 2022 Jul 2;14(7):e26519. doi: 10.7759/cureus.26519. eCollection 2022 Jul.
While severe acute respiratory syndrome (SARS) is the most common presentation of coronavirus disease 2019 (COVID-19) infection, several short- and long-term complications from COVID-19 infection are also being recognized. One such complication with life-threatening consequences is known as multisystem inflammatory syndrome in adults (MIS-A). While the phenomenon of multisystem inflammatory syndrome in children (MIS-C) is more recognized, the pathophysiology of both presentations remains a mystery currently. Several theories have been put forward however no consensus has been established yet. We present the case of a 20-year-old male who was admitted to the intensive care unit for a multisystem illness characterized by severe biventricular failure, profound shock, and acute liver and kidney injuries. The severity of illness necessitated the treatment with mechanical ventilation, extracorporeal membrane oxygenation (ECMO), vasopressors, and continuous veno-venous hemofiltration (CVVH). The patient was treated with one dose of intravenous immune globulin (IVIG). In association with the foregoing treatment, the patient made dramatic recovery and came off pulmonary, hemodynamic, and renal support within a week and made remarkably quick and full recovery. This case highlights a rare presentation of a COVID-19 complication that requires prompt recognition, supportive care, and empiric treatment that led to a favorable outcome in this case.
虽然严重急性呼吸综合征(SARS)是冠状病毒病2019(COVID-19)感染最常见的表现,但COVID-19感染的一些短期和长期并发症也逐渐被认识到。一种具有危及生命后果的并发症被称为成人多系统炎症综合征(MIS-A)。虽然儿童多系统炎症综合征(MIS-C)现象更为人所知,但目前这两种表现的病理生理学仍然是个谜。然而,已经提出了几种理论,但尚未达成共识。我们报告一例20岁男性病例,该患者因多系统疾病入住重症监护病房,其特征为严重双心室衰竭、严重休克以及急性肝损伤和肾损伤。病情严重程度需要进行机械通气、体外膜肺氧合(ECMO)、血管升压药和持续静脉-静脉血液滤过(CVVH)治疗。该患者接受了一剂静脉注射免疫球蛋白(IVIG)治疗。在上述治疗的配合下,患者病情显著好转,一周内脱离了肺部、血流动力学和肾脏支持,并迅速完全康复。该病例突出了COVID-19并发症的一种罕见表现,需要及时识别、支持性治疗和经验性治疗,本病例由此取得了良好的结果。