Multisystem inflammatory syndrome: A case report
International Journal of Rheumatic Diseases
; 26(Supplement 1):351.0, 2023.
Artigo
em Inglês
| EMBASE | ID: covidwho-2229336
ABSTRACT
Background:
Multisystem inflammatory syndrome is a rare but severe complication of Coronavirus 19 infection (COVID-19) occurring about 2-12 weeks after the initial infection. It was initially reported in children (MIS-C) but later identified in adults (MIS-A). We report a case of MIS-A in a patient presenting with myocarditis.\Method:
Case reportResults:
A 36 years old female admitted due to 3 days history of fever and severe epigastric pain. She had exposure to a relative with COVID-19 3 weeks prior to symptoms and antigen test done was negative. On the day of admission, she started to experience shortness of breath and easy fatigability during activities of daily living. Upon examination, she was hypotensive requiring vasopressors. 12 lead ECG showed acute anteroseptal wall myocardial infarction and 2D echocardiography revealed hypokinesia of the entire interventricular septum and inferior left ventricular free wall, and reduced ejection fraction (EF) at 43.3%. Coronary angiogram showed normal findings. On work-up, she had mild normochromic, normocytic anemia, normal serum lipase, elevated AST 222 (<34 U/L), ALT 250 (<49 U/L), Troponin T > 2000 ng/L, CPK-Total 669 (<192 U/L), Ferritin 456.90 (<204 ng/ml), ESR 13 mm/hr, CRP 24 (<6 mg/L) and procalcitonin 0.35 (<0.5 ng/ml). Infectious workup revealed negative results and PCR for COVID-19 was negative. However, further workup revealed COVID-19 Enzyme Linked Fluorescent Assay (ELFA) IgG positive at 44.75 (>1.00) and IgM negative. The patient was managed as a case of MIS-A and was started on intravenous immunoglobulin (IVIg) and short course steroids with significant improvement in symptoms. On the 10th day of hospitalization, follow-up 2D echocardiography showed improvement in previously noted ventricular wall hypokinesia and normalization of EF to 55.8%. The patient was discharged well and improved. Conclusion(s) Diagnosis of MIS-A is challenging in patients without a previously known COVID-19. A positive serology result is required to fulfill the case definition of MIS-A. Determining a history of COVID-19 and its relationship to a patient's clinical course is important for making diagnosis and determining subsequent management.
adult; aspartate aminotransferase level; case report; clinical article; conference abstract; coronavirus disease 2019; daily life activity; dyspnea; electrocardiogram; electrocardiography; epigastric pain; female; ferritin blood level; fever; follow up; heart ejection fraction; heart infarction; heart left ventricle; hospital discharge; hospitalization; human; human tissue; hypokinesia; interventricular septum; myocarditis; normochromic normocytic anemia; null result; serology; systemic inflammatory response syndrome; triacylglycerol lipase blood level; two dimensional echocardiography; antigen; antihypertensive agent; C reactive protein; endogenous compound; ferritin; human immunoglobulin; immunoglobulin G; immunoglobulin M; procalcitonin; steroid; troponin T
Texto completo:
Disponível
Coleções:
Bases de dados de organismos internacionais
Base de dados:
EMBASE
Tipo de estudo:
Relato de caso
/
Estudo de coorte
/
Estudo prognóstico
Idioma:
Inglês
Revista:
International Journal of Rheumatic Diseases
Ano de publicação:
2023
Tipo de documento:
Artigo
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