ABSTRACT
AIMS & OBJECTIVES: Multisystem inflammatory syndrome in children (MIS-C) is a severe Kawasaki-like disease seen in a fraction of children with SARS-COV-2. The syndrome's sequelae are still being defined. We present a 17-year-old female with MIS-C and acute biventricular heart failure (BVHF). We highlight her presentation, clinical course, management, and outcomes. METHODS: Design: Case report Setting: Pediatric intensive care unit (PICU) in an academic hospital Participant: 17-yearold female with MIS-C and BVHF RESULTS: A 17-year-old overweight female with asthma was admitted to the PICU with MIS-C. A history of SARS-COV-2 infection was confirmed with positive nasopharyngeal swab and IgG antibody and borderline IgM antibody. She presented with hypotension, fevers, abdominal pain, myalgias, and headache, but no chest pain. Initial diagnostic studies were notable for troponin I 2.572 ng/ml, BNP 386 pg/mL, ECG with sinus tachycardia, and echocardiogram with normal function. Over two days her hypotension worsened despite increasing vasoactive therapy. Repeat echocardiogram revealed LVEF 30% and moderate right systolic dysfunction consistent with acute heart failure. She received intravenous immune globulin (400 mg/kg) once, dexamethasone (6 mg daily), and Tocilizumab. Within 48 hours of these treatments she was weaned off all vasoactive therapies and extubated. Repeat echocardiogram near time of discharge showed improved LVEF 55%. She was discharged home after 8 days. CONCLUSIONS: MIS-C is a severe hyperinflammatory disease in a fraction of pediatric patients with COVID-19. Acute heart failure is a known, but uncommon, devastating complication of MIS-C that may resolve with prompt and aggressive treatment of the underlying hyperinflammatory syndrome.
ABSTRACT
This special issue is a reflection by tourism scholars on the initial impacts of the COVID-19 pandemic on the world, with travel and tourism being among the most significant areas to bear those impacts. However, instead of an analysis of the impacts of COVID-19 on tourism places and sectors, the papers in this issue focus on visions of how the pandemic events of 2020 are contributing to a possibly substantial, meaningful and positive transformation of the planet in general, and tourism specifically. This is not a return to a 'normal' that existed before - but is instead a vision of how the world is changing, evolving, and transforming into something different from what it was before the 2020 global pandemic experience.