Multisystem Inflammatory Syndrome in a Young Adult During the Second Wave of COVID-19 Pandemic in India ABS0116)
Indian Journal of Critical Care Medicine
; 26:S55-S56, 2022.
Article
in English
| EMBASE | ID: covidwho-2006349
ABSTRACT
Aim and background:
Since June 2020, there have been several reports of multisystem inflammatory syndrome in adults (MIS-A). There is a paucity of a description of MIS-A from India. Materials andmethods:
A 26-year-old, healthy male, with a previous history of COVID-19, without any known history of chronic disease, with clinical characteristics resembling MIS-A was hospitalised on May 30, 2021.Results:
Case presentation The patient presented with 1 week of persistent high-grade fever (102-degree F) with chills and rigor. The concomitant complaints were left-sided pain in the buccal cavity, left facial swelling, intra-orbital pain, and watery eyes. The respiratory rate was 24/minute, SpO2 was 96% on room air. Ever since the recovery from COVID-19 (1 week back), there was severe pain in the throat with difficulty in breathing, generalised weakness, and loss of appetite. BP was 130/80 mm Hg. The hospital course was notable for profound systemic inflammation, requiring ICU admission. MRI revealed discrete subcentimetric bilateral deep cervical lymph nodes. Blood tests at admission revealed, lymphopenia 15.3%, CRP 61.84 mg/L, total leucocyte count 12.93 (1000/μL), neutrophils 78.7%. Red distribution width (RDW) was marginally elevated to 15%. The patient was managed by IV fluids, IV immunoglobulin. Scrub typhus was excluded by IgM ELISA IgM with a negative titre (0.095). Widal test was negative and excluded enteric fever. d-dimer was within normal limits (125 ng/ mL). Borderline elevation of hepatic enzymes was noted. There was a high SARS-CoV-2 IgII titres (12050.4). The patient improved following intravenous immunoglobulin (IVIG), IV ascorbic acid, dexamethasone, supportive care and was discharged on day 4, with methylprednisolone for 1 week.Conclusion:
Specific treatment is yet to be determined. However, dexamethasone and IVIG allowed controlling the inflammatory process. MIS-A, as a delayed immune complication, requires early recognition, with a multidisciplinary approach and aggressive therapeutic intervention, to yield favourable outcomes. MIS-A should be considered in adults, during the recovery phase from COVID-19. This is perhaps, the first description of MIS-A from India during the second wave of the COVID-19 pandemic. The role of IVIG needs further exploration.
ascorbic acid; D dimer; dexamethasone; endogenous compound; human immunoglobulin; immunoglobulin M; methylprednisolone; adult; ambient air; asthenia; breathing rate; case report; cervical lymph node; chill; chronic disease; clinical article; clinical feature; complication; conference abstract; coronavirus disease 2019; dyspnea; enzyme linked immunosorbent assay; epiphora; eye pain; face; fever; human; human cell; hypertransaminasemia; immunoglobulin blood level; India; inflammation; intravenous drug administration; leukocyte count; loss of appetite; lymphocytopenia; male; mouth cavity; neutrophil; nonhuman; nuclear magnetic resonance imaging; pandemic; red blood cell distribution width; rigor; scrub typhus; Severe acute respiratory syndrome coronavirus 2; sore throat; swelling; systemic inflammatory response syndrome; typhoid fever; young adult
Full text:
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Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Indian Journal of Critical Care Medicine
Year:
2022
Document Type:
Article
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