ABSTRACT
Objectives: Several case series have been identified describing adult patients with a secondary Multisystem Inflammatory Syndrome (MIS) after a recent COVID-19 infection, presenting with features similar to Kawasaki Disease (KD). This paper aims to describe the first case of Kawasaki-like presentation in an adult Filipino with COVID-19 infection. Method(s): A case of Kawasaki-like presentation in an adult Filipino with COVID-19 infection was reviewed in a tertiary hospital. Result(s): This is a case of a 38-year- old Filipino woman who presented with fever, malaise, dry cough, sore throat, diarrhea and rashes. On examination, she had classic features of KD: non-exudative conjunctivitis, cracked lips, edema of the hands and feet, palmar erythema, diffuse rash, and cervical lymphadenopathy. Laboratory results showed anemia, leukocytosis with neutrophilia, hyponatremia, hypokalemia, transaminitis, hypoalbuminemia, and elevated inflammatory markers. COVID-19 PCR test was negative but serologic studies showed positivity for IgM and IgG, suggesting a recent infection. Treatment included methylprednisolone pulse therapy, intravenous immunoglobulin (IVIG) and anticoagulation, which resulted in rapid clinical improvement. Conclusion(s): As the knowledge of COVID-19 and its associated clinical features continually evolves, it is imperative to be aware of the possibility of KD as a delayed post-viral multisystem inflammatory response in adults that may warrant prompt treatment.
ABSTRACT
Objectives: We aimed to reveal the skin, mucous membrane, hair and nail findings of children who meet the multisystem inflammatory syndrome in children (MIS-C) criteria. Method: A prospective case series consisting of 43 children who applied to Karadeniz Technical University Faculty of Medicine Farabi Hospital between January 2020 and January 2022 and met the criteria for MIS-C according to the diagnostic criteria of the Centers for Disease Control and Prevention was conducted. Results: Of 43 patients diagnosed with MIS-C, 18 (%41,9) were female and 25 (%58,1) were male. The mean age of the patients is 7.63, the age range is between 7 months and 15 years. The results of polymerase chain reaction tests for SARS-CoV-2 were positive for 4 (%9,3) patients, and the results of SARS-CoV-2 immunoglobulin G tests were positive for 39 (%90,7) patients. No mucocutaneous involvement was observed in 3 (%6,9) of the patients. Nonpurulent conjunctivitis was observed in 25 (%58,1) patients, and periorbital edema was observed in 4 (%9,3) patients. 4 (%9,3) patients had symmetrical edema of the hands and feet, and 2 (%4,6) patients had periungual desquamation. While no oral mucosal findings were observed in 15 (%34,9) patients;12 (%27,9) patients had fissured lips, 10 (% 23,3) had cheilitis, 8 (%18,6) had diffuse hyperemia of the oral mucosa, 6 (%13,9) had strawberry tongue, and 3 (%6,9) had herpes labialis. 21 (%48,8) of the patients had urticarial, 12 (%27,9) of them maculopapular, 5 (%11,6) patients livedoid and 1 (%2,3) patient had a skin rash compatible with pseudopernio. No hair or nail changes were observed in the patients while they were hospitalized. Discussion: In this case series of hospitalized children with definitive MIS-C during the COVID-19 pandemic, a wide spectrum of mucocutaneous findings was identified.
ABSTRACT
Introduction: Children mostly have mild or asymptomatic forms of SARS-CoV-2 infection, but during pandemic a higher incidence of Kawasaki disease, Kawasaki-like syndrome and the emergence of a new clinical entity, multisystem inflammatory post-covid syndrome (MIS-C) has also been observed. Objectives: The aim of this study is to determine clinical features and laboratory findings in patients with MIS-C. Methods: Retrospective analysis of clinical features and laboratory findings of MIS-C patients treated at our tertiary referal center (Clinic of Pediatric, University Clinical Centre Nis, Serbia). Results: From 18th of March 2020 till 30st of April 2021 there were 10 patients diagnosed as MIS-C according to CDC criteria. Eight patients were male and two were female. Patients age was 2 to 13 years (average 7.9 years, median 7 years). All patients had SARS -CoV-2 N-protein IgG antibodies but without history of disease symptoms and had positive contact four weeks prior to the onset of MIS-C symptoms. First symptom of MIS-C was fever (over 38C) which lasted in average for 4.4 days (3-7 days). Muco-cutaneous and gastrointestinal manifestations were most common. All patients had bulbar conjuctivitis, rash was present in 8 patients (80%), hand/foot oedema in 6 cases (60%), anterior cervical lymphadenopathy and cheliitis in 4 cases (40%) and periobital oedema in one case (details presented in Table 1. Clinical features of MIS-C patients). Nine patients (90%) presented with gastrointestinal symptoms while nervous system was affected in 5 patients. Three patients developed heart insuffitiency and one patient developed early signs of right coronary arthery aneurism. All patients had elevated inflammatory markers. Complete blood count showed elevated levels of white blood cells in 9 patients. Hypoalbuminemia and hypoproteinemia, low levels of serum potassium and sodium were present during ten days after the onset of symptoms. Troponines were elevated in 4 cases, proBNP in 5 cases. Abdominal ultrasound was performed and 6 patients presented with hepatoplenomegaly, 3 with enlarged spleen, one with enlagred liver and 4 had ascites. All patients were treated with combination of two antibiotics till cultures were proven negative, corticosteroid therapy and antiaggregation therapy. Three patients received a IVIG in a single dose (2gr/kg). All patients had good response to corticosteroid therapy (2mg/kg). Corticosteroid therapy was continued for four weeks (tapering). Conclusion: MIS-C can be a life-threatening condition in children. Early diagnosis and timely adequate treatment are of paramount importance. In children less than 5 years of age, the distinction between Kawasaki (Kawasaki shock) syndrome and MIS-C might be difficult, influencing the decision to use IVIG or steroids alone.