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Multisystem inflammatory syndrome with refractory cardiogenic shock due to acute myocarditis and mononeuritis multiplex after SARS-CoV-2 infection in an adult.
Othenin-Girard, Alexandra; Regamey, Julien; Lamoth, Frédéric; Horisberger, Alice; Glampedakis, Emmanouil; Epiney, Jean-Benoit; Kuntzer, Thierry; de Leval, Laurence; Carballares, Maude; Hurni, Claire-Anne; Rusca, Marco; Pantet, Olivier; Di Bernardo, Stefano; Oddo, Mauro; Comte, Denis; Piquilloud, Lise.
  • Othenin-Girard A; Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland / Anaesthesiology Service, Lausanne University Hospital, Lausanne, Switzerland.
  • Regamey J; Cardiology Service, Lausanne University Hospital, Lausanne, Switzerland.
  • Lamoth F; Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland / Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland / University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland.
  • Horisberger A; Immunology and Allergy Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
  • Glampedakis E; Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.
  • Epiney JB; Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland.
  • Kuntzer T; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland / Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland.
  • de Leval L; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland / Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital, Lausanne, Switzerland.
  • Carballares M; Emergency Medicine Service, Lausanne University Hospital, Lausanne, Switzerland.
  • Hurni CA; Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland.
  • Rusca M; Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland.
  • Pantet O; Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland / University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland.
  • Di Bernardo S; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland / Paediatric Cardiology Service, Department of Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland.
  • Oddo M; Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland / University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland.
  • Comte D; University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland / Immunology and Allergy Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
  • Piquilloud L; Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland / University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland.
Swiss Med Wkly ; 150: w20387, 2020 11 02.
Article in English | MEDLINE | ID: covidwho-922917
ABSTRACT
A 22-year-old male with a typical history of pauci-symptomatic COVID-19 3 weeks earlier, confirmed by positive serology for SARS-CoV-2 (IgG), was admitted to the intensive care unit because of severe myocarditis with refractory cardiogenic shock that required extracorporeal life support. Due to a clinical presentation suggestive of Kawasaki-like disease with coronary aneurysm and severe systemic inflammation, intravenous immunoglobulins were administered in combination with tocilizumab. The initial clinical course was favourable with these treatments. However, the patient subsequently developed a severe mononeuritis multiplex leading to bilateral foot drop, which required intensive immunosuppressive therapy (corticosteroids, cyclophosphamide and rituximab). The clinical presentation meets the criteria for multisystem inflammatory syndrome associated with SARS-CoV-2, but includes very severe organ damages. Early recognition, a multidisciplinary approach and aggressive therapeutic intervention can lead to a favourable outcome.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Shock, Cardiogenic / Systemic Inflammatory Response Syndrome / Mononeuropathies / COVID-19 / Myocarditis Type of study: Case report / Prognostic study Topics: Long Covid Limits: Adult / Humans / Male / Young adult Language: English Journal: Swiss Med Wkly Journal subject: Medicine Year: 2020 Document Type: Article Affiliation country: Smw.2020.20387

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Shock, Cardiogenic / Systemic Inflammatory Response Syndrome / Mononeuropathies / COVID-19 / Myocarditis Type of study: Case report / Prognostic study Topics: Long Covid Limits: Adult / Humans / Male / Young adult Language: English Journal: Swiss Med Wkly Journal subject: Medicine Year: 2020 Document Type: Article Affiliation country: Smw.2020.20387