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Kawasaki-like Syndrome as an Emerging Complication of SARS-CoV-2 Infection in Young Adults
César Burgi Vieira1, Ana Teresa Ferreira2, Filipa Botelho Cardoso3
1Unidade Funcional Medicina 2.4, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.
Insights
Multisystem inflammatory syndrome in children (MIS-C) can present atypically in young adults with COVID-19. Early recognition and treatment are crucial for managing this Kawasaki-like illness.
Area of Science:
- Pediatrics
- Infectious Diseases
- Cardiology
Background:
- The COVID-19 pandemic has seen the emergence of Kawasaki-like syndromes in children, termed MIS-C (CDC) and PIMS-TS (ECDC).
- These syndromes represent a significant inflammatory response associated with SARS-CoV-2 infection.
Purpose of the Study:
- To report a case of MIS-C/PIMS-TS in an 18-year-old male.
- To highlight the diagnostic challenges and atypical presentations of COVID-19 in young adults.
Main Methods:
- Case report of an 18-year-old male with abdominal pain, fever, rash, vomiting, and diarrhea.
- Diagnosis of SARS-CoV-2 infection and severe cardiac dysfunction (low ejection fraction, low cardiac index).
- Treatment with inotropic/vasopressor support, followed by aspirin, corticosteroids, and immunoglobulin for MIS-C/PIMS-TS criteria.
Main Results:
- The patient presented with shock and was initially suspected of having cholecystitis.
- Echocardiography revealed significant cardiac dysfunction and elevated troponin levels.
- The patient showed a good clinical response to the treatment for MIS-C/PIMS-TS.
Conclusions:
- Atypical presentations of COVID-19, such as MIS-C/PIMS-TS, can be misdiagnosed, especially in younger populations.
- Physicians must maintain a high index of suspicion for MIS-C/PIMS-TS in teenagers and young adults presenting with COVID-19 and concerning symptoms.
Background:
Kawasaki-like syndrome occurring in children during the COVID-19 pandemic has been labelled multisystem inflammatory syndrome in children (MIS-C) by the CDC and paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) by the ECDC.
Case Report:
We report the case of an 18-year-old male patient presenting with a 72-hour history of abdominal pain, fever, erythematous skin rash, vomiting and diarrhoea. Examination showed he also had shock and he was first thought to have oedematous cholecystitis. SARS-CoV-2 infection was also diagnosed. He was admitted to the ICU, and echocardiography showed cardiac dysfunction, with a low ejection fraction and low cardiac index. High-sensitivity troponin serum levels were elevated. The patient received inotropic and vasopressor support. As he fulfilled several criteria for MIS-C/PIMS-TS, he was administered acetylsalicylic acid, corticosteroids and immunoglobulin, with a good clinical response.
Conclusion:
This case emphasizes how this severe presentation of COVID-19 can easily be misdiagnosed if the clinician is less aware of this syndrome in younger patients.
Learning Points:
SARS-CoV-2 infection is a diagnostic challenge in some patients with atypical clinical presentations, who may have MIS-C/PIMS-TS.Physicians should be aware of this condition when evaluating teenagers and young adults with COVID-19.
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