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1.
BMJ Case Rep ; 14(10)2021 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-34607815

RESUMO

This is a case of a 47-year-old woman with a spontaneous haemoperitoneum secondary to uterine leiomyomas (fibroids), an important differential diagnosis in patients with uterine fibroids and hypovolaemic shock. Uterine fibroids are very common in women of reproductive age, yet little is taught about their potential to cause hypovolaemic shock. Although it is a rare complication, given the prevalence of fibroids, it is important to bear this life-threatening differential in mind to optimise the care for these women. Presentation typically involves abdominal pain, syncope, haemodynamic instability and an intra-abdominal mass. CT of the abdomen and pelvis can be helpful in identifying the source of the haemoperitoneum, but should not delay surgery, which is the definitive management.


Assuntos
Leiomioma , Choque , Neoplasias Uterinas , Diagnóstico Diferencial , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Leiomioma/complicações , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Pessoa de Meia-Idade , Choque/etiologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/cirurgia
2.
Chin Med J (Engl) ; 134(19): 2299-2305, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34629416

RESUMO

BACKGROUND: Functional mitral regurgitation (FMR) is common in critically ill patients and may cause left atrial (LA) pressure elevation. This study aims to explore the prognostic impact of synergistic LA pressure elevation and FMR in patients with shock. METHODS: We retrospectively screened 130 consecutive patients of 175 patients with shock from April 2016 to June 2017. The incidence and impact of FMR and early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio (E/e') ≥ 4 within 6 h of shock on the prognosis of patients were evaluated. Finally, the synergistic effect of FMR and E/e' were assessed by combination, grouping, and trend analyses. RESULTS: Forty-four patients (33.8%) had FMR, and 15 patients (11.5%) had E/e' elevation. A multivariate analysis revealed FMR and E/e' as independent correlated factors for 28-day mortality (P = 0.043 and 0.028, respectively). The Kaplan-Meier survival analysis revealed a significant difference in survival between patients with and without FMR (χ2 = 7.672, P = 0.006) and between the E/e' ≥ 14 and E/e' < 14 groups (χ2 = 19.351, P < 0.010). Twenty-eight-day mortality was significantly different among the four groups (χ2 = 30.141, P < 0.010). The risk of 28-day mortality was significantly higher in group 4 (E/e' ≥ 14 with FMR) compared with groups 1 (E/e' < 14 without FMR) and 2 (E/e' < 14 with FMR) (P = 0.001 and 0.046, respectively). CONCLUSIONS: Patients with shock can be identified by the presence of FMR. FMR and E/e' are independent risk factors for a poor prognosis in these patients, and prognosis is worst when FMR and E/e' ≥ 14 are present. It may be possible to improve prognosis by reducing LA pressure and E/e'. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03082326.


Assuntos
Insuficiência da Valva Mitral , Choque , Humanos , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Prognóstico , Estudos Retrospectivos
3.
Zhonghua Shao Shang Za Zhi ; 37(9): 831-838, 2021 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-34645148

RESUMO

Objective: To explore the risk factors of early enteral nutrition intolerance in extremely severe burn patients. Methods: A retrospective case-control study was performed. From January 2018 to December 2020, seventy-six adult patients with extremely severe burns who met the inclusion criteria were admitted to Hwa Mei Hospital of University of Chinese Academy of Sciences, including 55 males and 21 females, aged (45±11) years with burns of 62% (52%, 82%) total body surface area. Depending on the patient's tolerance to early enteral nutrition, they were divided into tolerance group (47 patients) and intolerance group (29 patients), and their clinical data were statistically analyzed, including age, sex, body mass index (BMI), underlying disease, total burn area, full-thickness burn area, abbreviated burn severity index (ABSI) score, implementation of mechanical ventilation on the day of admission, stable shock state, vomiting before feeding. The following data were recorded including the onset time, duration length, and frequency of enteral nutrition intolerance of patients in intolerance group, and the number of operations, the length of hospitalization, the occurrence of sepsis within 2 weeks after injury, the outcome, as well as the serum hypersensitive C-reactive protein (hs-CRP), albumin, fasting blood glucose, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transpeptidase (γ-GT) on post burn day (PBD) 1, 5, 9, and 13 of patients in the two groups. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test to screen the related factors of early enteral nutrition intolerance of the patients. Binary univariate and multivariate logistic regression analysis were used to analyze the independent risk factors of early enteral nutrition intolerance of the patients. Results: There were no statistically significant differences in age, sex, BMI, and percentage of underlying disease of patients between the two groups (P>0.05). The total burn area, full-thickness burn area, ABSI score, mechanical ventilation percentage on the day of admission, percentage of unstable shock period, percentage of vomiting before feeding of patients in intolerance group were significantly higher than those in tolerance group (Z=-4.559, -3.378, -4.067, χ2=18.375, 23.319, 8.339, P<0.01). In intolerance group, the onset time of intolerance was (9±4) d after injury, and the duration length was 4 (2, 6) d, with a total of 46 times occurred. Compared with tolerance group, the percentage of sepsis and mortality of patients in intolerance group were significantly higher within 2 weeks after injury (χ2=16.571, 12.665, P<0.01). The number of operation and length of hospitalization of patients in the two groups were similar (P>0.05); however the length of hospitalization of patients in the intolerance group was significantly more than that in tolerance group after excluding the death cases (Z=-2.266, P<0.05). On PBD 1, the level of fasting blood glucose and AST of patients in intolerance group were significantly higher than those in tolerance group (t=3.070, Z=-3.070, P<0.01). On PBD 5, the levels of hs-CRP, albumin, fasting blood-glucose, ALT, AST, and γ-GT of patients in the two groups were similar (P>0.05). On PBD 9, the level of hs-CRP of patients in intolerance group was significantly higher than that in tolerance group (t=2.836, P<0.01), and the levels of ALT and γ-GT of patients in intolerance group were significantly lower than those in tolerance group (Z=-3.932, -2.052, P<0.05 or P<0.01). On PBD 13, the level of hs-CRP of patients in intolerance group was significantly higher than that in tolerance group (t=3.794, P<0.01), and the levels of fasting blood glucose, ALT, and γ-GT of patients in intolerance group were significantly lower than those in tolerance group (t=-2.176, Z=-2.945, -2.250, P<0.05 or P<0.01). Binary univariate logistic regression analysis showed that total burn area, full-thickness burn area, ABSI score, implementation of mechanical ventilation on the day of admission, unstable shock period, vomiting before feeding, and fasting blood-glucose on PBD 1 of patients were related to early enteral nutrition intolerance (odds ratio=1.086, 1.052, 1.775, 9.167, 12.797, 10.125, 1.249, 95% confidence interval=1.045-1.129, 1.019-1.085, 1.320-2.387, 3.132-26.829, 4.199-39.000, 2.003-51.172, 1.066-1.464, P<0.01). Multivariate logistic regression analysis showed that the large total burn area, unstable shock period, vomiting before feeding, and high fasting blood-glucose on PBD 1 of patients were the independent risk factors of early enteral nutrition intolerance in patients (odds ratio=1.073, 6.390, 9.004, 1.246, 95% confidence interval=1.021-1.128, 1.527-26.734, 1.134-71.496, 1.007-1.540, P<0.05 or P<0.01). Conclusions: The percentage of early enteral nutrition intolerance is very high in extremely severe burn patients, which is closely related to poor prognosis. Large total burn area, vomiting before feeding, unstable shock phase, high fasting glucose on PBD 1 of patients are the independent risk factors for early enteral nutrition intolerance in extremely severe burn patients. The benefits and risks should be carefully evaluated before starting enteral nutrition in such patients, and early enteral nutrition should not be blindly pursued.


Assuntos
Nutrição Enteral , Choque , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
5.
BMJ Case Rep ; 14(9)2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521745

RESUMO

Most reports of COVID-19 in neonates suggest that they are infected postnatally and present with gastrointestinal or respiratory symptoms. We describe a neonate who had community-acquired COVID-19, and presented with late-onset sepsis and developed dyselectrolytemia. The 26-day-old male baby had fever, feed refusal and shock. Rapid antigen test for SARS-CoV-2 by nasopharyngeal swab was positive and levels of circulating inflammatory markers were high. The baby was supported with antibiotics, and inotropic and vasopressor drugs. He had seizures and bradycardia due to dyselectrolytemia on day 2 of admission. On day 3, he had respiratory distress, with non-specific chest radiographic findings, and was managed with non-invasive support for 24 hours. The baby was discharged after 8 days. On serial follow-up, he was breastfeeding well and gaining weight appropriately with no morbidity. Our report highlights a unique presentation of COVID-19, with late-onset infection and shock-like features along with dyselectrolytemia and seizures.


Assuntos
COVID-19 , Choque , Febre , Hospitalização , Humanos , Recém-Nascido , Masculino , SARS-CoV-2 , Choque/etiologia
6.
BMJ Case Rep ; 14(9)2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493552

RESUMO

This case report highlights the potentially serious side effects of hyoscine and how a seemingly innocuous patch may confound patients and doctors alike. It demonstrates how easy it is to miss an obvious diagnosis when in fact a thorough medical history including an exhaustive drug history can easily point us in the direction of the diagnosis fairly quickly. Finally, hyoscine may cause potentially serious side effects and patients who are taking it, either orally or transdermally, should be made aware of these.


Assuntos
Escopolamina , Choque , Humanos
7.
Andes Pediatr ; 92(3): 395-405, 2021 Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34479246

RESUMO

INTRODUCTION: In April 2020, the pediatric multisystem inflammatory syndrome temporarily associated with COVID-19 (MIS-C) was described for the first time. MIS-C could have a severe course and may require critical care support. OBJECTIVE: To describe the clinical, laboratory, and management characteristics of hospitalized children who meet MIS-C criteria with severe presentation in a pediatric critical pa tient unit. PATIENTS AND METHOD: Descriptive prospective study of children with severe MIS-C mana ged by treatment phases with immunoglobulin and methylprednisolone, according to their clinical response. Epidemiological, clinical, laboratory and imaging data were obtained. Phenotypes were classified into Kawasaki and not Kawasaki, comparing their findings. RESULTS: 20 patients were analy zed, the median age was 6 years, 60% were female, and 40% presented comorbidity. SARS-CoV-2 was detected in 90% of the patients. They presented fever as the first symptom, followed by brief and early gastrointestinal symptoms (70%). 75% presented the Kawasaki phenotype. They evolved with lymphopenia, hypoalbuminemia, coagulation alterations, and elevated systemic and cardiac in flammatory parameters. 80% of the cases presented echocardiographic alterations and 90% shock that required critical care support. All the patients had a short and favorable evolution. All patients responded to the established therapy, but 40% required a second phase of treatment. There were no differences when comparing phenotypes. No deaths were reported. CONCLUSION: MIS-C is a new childhood disease whose presentation could be life-threatening. It requires early suspicion, immuno modulatory management, critical care support, and a multidisciplinary approach to obtain the best results and optimize its prognosis.


Assuntos
COVID-19 , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/etiologia , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/terapia , Criança , Cuidados Críticos , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Hipoalbuminemia/etiologia , Imunoglobulinas Intravenosas/administração & dosagem , Fatores Imunológicos/administração & dosagem , Unidades de Terapia Intensiva Pediátrica , Linfopenia/etiologia , Masculino , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Estudos Prospectivos , SARS-CoV-2/isolamento & purificação , Choque/etiologia , Choque/terapia , Avaliação de Sintomas , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia
8.
Med Klin Intensivmed Notfmed ; 116(6): 541-553, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34338810

RESUMO

Circulatory shock requires treatment of the underlying pathology in addition to supportive pharmacological therapy that is guided by hemodynamic monitoring. Based on the evaluation of the patient's volume, perfusion and cardiac status, the following therapeutic goals should be achieved: (1) Normalization of the intra- and extravascular fluid volume. (2) Provision of sufficient perfusion pressure and organ perfusion. (3) Optimization of cardiac function including protecting an ischemic and exhausted myocardium from overload. The most important therapeutic substances are balanced electrolyte solutions and the vasopressor noradrenaline. Because there is little scientific evidence for the use of alternative drugs, these should only be given if there is a good pathophysiologic rationale and if their effect is continuously monitored and re-evaluated.


Assuntos
Choque , Hidratação , Hemodinâmica , Humanos , Monitorização Fisiológica , Norepinefrina , Choque/tratamento farmacológico , Vasoconstritores/efeitos adversos
10.
BMC Psychiatry ; 21(1): 387, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348698

RESUMO

BACKGROUND: Several fatal medical complications have been associated with alcohol withdrawal, such as seizure, cardiac arrhythmia, and takotsubo cardiomyopathy. However, there have been no reports on hypovolemic shock during alcohol withdrawal, although two physical signs of alcohol withdrawal, i.e., diaphoresis and fever, can lead to hypovolemia and its medical consequences. CASE PRESENTATION: We describe a patient with alcohol use disorder who exhibited hypovolemic shock and its associated acute renal failure during alcohol withdrawal with severe diaphoresis and fever even though he had consumed almost the full amount of food he was offered. Given his excessive diaphoresis and fever that were related to alcohol withdrawal, his water intake was insufficient. Infusion with extracellular fluid resolved all these medical issues. CONCLUSIONS: The increased adrenergic activity associated with alcohol withdrawal might substantially increase a patient's water-intake requirement through diaphoresis and fever and may cause severe hypovolemia and its associated medical complications.


Assuntos
Alcoolismo , Choque , Síndrome de Abstinência a Substâncias , Cardiomiopatia de Takotsubo , Alcoolismo/complicações , Humanos , Masculino , Choque/etiologia , Síndrome de Abstinência a Substâncias/complicações
11.
Ned Tijdschr Geneeskd ; 1652021 08 05.
Artigo em Holandês | MEDLINE | ID: mdl-34351718

RESUMO

BACKGROUND: Ovulation may lead to abdominal pain. It is well-known that ovulation can cause intra-abdominal bleeding. However, literature on hypovolemic shock due to an ovarian bleeding is scarce. CASE DESCRIPTION: A 30-year-old woman visited the emergency room because of acute pain of the lower abdomen. Her skin was pale, her vital signs were normal and a pregnancy test was negative. At presentation, her blood pressure decreased to 87/50 mmHg. Therefore, intra-abdominal bleeding was suspected and the gynecologist was consulted. On ultrasound, intraperitoneal fluid was seen, so we proceeded to emergency laparoscopy. During surgery, we found a bleeding corpus luteum (corpus rubrum) leading to 2.5 L of free intra-abdominal blood. The bleeding was stopped intraoperatively. CONCLUSION: A bleeding corpus luteum can lead to hypovolemic shock. Ovarian bleeding should be considered in case of shock combined with lower abdominal pain, ultrasound should be performed promptly and the gynecologist has to be consulted.


Assuntos
Choque , Dor Abdominal , Adulto , Feminino , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Ovário , Gravidez , Choque/etiologia , Ultrassonografia
12.
J Card Surg ; 36(10): 3711-3718, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34310744

RESUMO

BACKGROUND AND AIM OF THE STUDY: Although dopamine and norepinephrine are recommended as first-line agents in the treatment of shock, it is unclear which is the optimal vasoactive inotropic agent (VIA) to manage postcardiotomy circulatory shock. This single-center, randomized clinical trial aimed to investigate the efficacy and safety of dopamine versus norepinephrine in postcardiotomy circulatory shock. METHODS: We randomly assigned the patients with postcardiotomy circulatory shock to receive either dopamine or norepinephrine. When shock persisted despite the dose of 20 µg/kg/min of dopamine or the dose of 0.2 µg/kg/min of norepinephrine, epinephrine or vasopressin could be added. The primary endpoint was new-onset tachyarrhythmic event during drug infusion. Secondary endpoints included requirement of additional VIAs, postoperative complications, and all-cause mortality within 30 days of drug initiation. RESULTS: At the planned interim analysis of 100 patients, the boundary for the benefit of norepinephrine has been crossed, and the study was stopped early. Excluding two patients withdrawing a consent, 48 patients were assigned to dopamine and 50 patients to norepinephrine. New-onset tachyarrhythmic event occurred in 12 (25%) patients in the dopamine and one (2%) patient in the norepinephrine group (p = .009). The requirement for additional VIAs was more common in the dopamine group (p < .001). Other secondary endpoints were similar between groups. CONCLUSIONS: Despite the limited study subjects with early determination, in patients with postcardiotomy circulatory shock, dopamine as a first-line vasopressor was associated with higher tachyarrhythmic events and greater need for additional VIAs compared with norepinephrine.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Choque Séptico , Choque , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Dopamina , Humanos , Norepinefrina , Choque/tratamento farmacológico , Choque/etiologia , Choque Séptico/tratamento farmacológico , Vasoconstritores , Vasopressinas
15.
Ulus Travma Acil Cerrahi Derg ; 27(4): 486-489, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34212991

RESUMO

Rupture of gynecologic tumors secondary to trauma rarely occurs. Rupture can lead to acute abdominal pain due to hemorrhage from the ruptured area and organs; rupture can also lead to peritonitis, depending on the size of the tumor. We describe the case of giant epithelial ovarian tumor rupture exhibiting due to minor trauma and the development of hypovolemic shock. A 69-year-old female patient was admitted to the emergency room with complaints of acute abdominal pain and subsequent clouding of consciousness after falling down while walking. Emergency abdominal computed tomography scan revealed widespread hemorrhagic free fluid in the abdominal cavity and a mass measuring 27.5 cm × 21 cm × 15 cm, extending from the right quadrant of the abdomen to the left. The patient underwent an emergency operation due to hypovolemic shock. During surgery, a totally ruptured mass lesion arising from the right ovary was seen; the mass contained cystic components and measured approximately 30 cm × 20 cm × 15 cm. Hemostasis was achieved in the bleeding areas, and the right ovarian mass was totally resected. The patient was discharged as cured on the 6th post-operative day. Gynecologic tumor rupture due to trauma is a rare event. However, it is a clinical condition that should be kept in mind regardless of the type of trauma. This is especially true in patients who experienced trauma and were radiologically found to have intra-abdominal hemorrhage with normal-appearing solid organs, such as liver and spleen, that frequently cause bleeding.


Assuntos
Neoplasias Ovarianas , Choque , Idoso , Feminino , Humanos , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Ovário/diagnóstico por imagem , Ovário/cirurgia , Ruptura Espontânea , Choque/diagnóstico , Choque/etiologia , Choque/cirurgia , Tomografia Computadorizada por Raios X
16.
N Engl J Med ; 385(1): 23-34, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34133855

RESUMO

BACKGROUND: The assessment of real-world effectiveness of immunomodulatory medications for multisystem inflammatory syndrome in children (MIS-C) may guide therapy. METHODS: We analyzed surveillance data on inpatients younger than 21 years of age who had MIS-C and were admitted to 1 of 58 U.S. hospitals between March 15 and October 31, 2020. The effectiveness of initial immunomodulatory therapy (day 0, indicating the first day any such therapy for MIS-C was given) with intravenous immune globulin (IVIG) plus glucocorticoids, as compared with IVIG alone, was evaluated with propensity-score matching and inverse probability weighting, with adjustment for baseline MIS-C severity and demographic characteristics. The primary outcome was cardiovascular dysfunction (a composite of left ventricular dysfunction or shock resulting in the use of vasopressors) on or after day 2. Secondary outcomes included the components of the primary outcome, the receipt of adjunctive treatment (glucocorticoids in patients not already receiving glucocorticoids on day 0, a biologic, or a second dose of IVIG) on or after day 1, and persistent or recurrent fever on or after day 2. RESULTS: A total of 518 patients with MIS-C (median age, 8.7 years) received at least one immunomodulatory therapy; 75% had been previously healthy, and 9 died. In the propensity-score-matched analysis, initial treatment with IVIG plus glucocorticoids (103 patients) was associated with a lower risk of cardiovascular dysfunction on or after day 2 than IVIG alone (103 patients) (17% vs. 31%; risk ratio, 0.56; 95% confidence interval [CI], 0.34 to 0.94). The risks of the components of the composite outcome were also lower among those who received IVIG plus glucocorticoids: left ventricular dysfunction occurred in 8% and 17% of the patients, respectively (risk ratio, 0.46; 95% CI, 0.19 to 1.15), and shock resulting in vasopressor use in 13% and 24% (risk ratio, 0.54; 95% CI, 0.29 to 1.00). The use of adjunctive therapy was lower among patients who received IVIG plus glucocorticoids than among those who received IVIG alone (34% vs. 70%; risk ratio, 0.49; 95% CI, 0.36 to 0.65), but the risk of fever was unaffected (31% and 40%, respectively; risk ratio, 0.78; 95% CI, 0.53 to 1.13). The inverse-probability-weighted analysis confirmed the results of the propensity-score-matched analysis. CONCLUSIONS: Among children and adolescents with MIS-C, initial treatment with IVIG plus glucocorticoids was associated with a lower risk of new or persistent cardiovascular dysfunction than IVIG alone. (Funded by the Centers for Disease Control and Prevention.).


Assuntos
COVID-19/tratamento farmacológico , Glucocorticoides/uso terapêutico , Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Disfunção Ventricular Esquerda/prevenção & controle , Adolescente , COVID-19/complicações , COVID-19/imunologia , COVID-19/mortalidade , Criança , Pré-Escolar , Estudos de Coortes , Terapia Combinada , Quimioterapia Combinada , Feminino , Hospitalização , Humanos , Imunomodulação , Lactente , Modelos Logísticos , Masculino , Pontuação de Propensão , Vigilância em Saúde Pública , Choque/etiologia , Choque/prevenção & controle , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Síndrome de Resposta Inflamatória Sistêmica/mortalidade , Resultado do Tratamento , Disfunção Ventricular Esquerda/etiologia , Adulto Jovem
19.
J Korean Med Sci ; 36(25): e181, 2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34184438

RESUMO

Multisystem inflammatory disease in children is a Kawasaki disease like illness occurring after severe acute respiratory syndrome coronavirus 2 infection in children. As the pandemic progresses, similar syndromes were also reported in adult with a decreased incidence. Multisystem inflammatory syndrome in adults (MIS-A) can be characterized with shock, heart failure, and gastrointestinal symptoms with elevated inflammatory markers after coronavirus disease 2019 (COVID-19) infection. Herein, we describe the first case of MIS-A in South Korea. A 38-year-old man presented to our hospital with a 5-day history of abdominal pain and fever. He had been treated with antibiotics for 5 days at the previous hospital, but symptoms had worsened and he had developed orthopnea on the day of presentation. He suffered COVID-19 six weeks ago. Laboratory data revealed elevated white blood cell counts with neutrophil dominance, C-reactive protein, and B-type natriuretic peptide. Chest X-ray showed normal lung parenchyme and echocardiography showed severe biventricular failure with normal chamber size. We diagnosed him as MIS-A and treated with intravenous immunoglobulin and steroid.


Assuntos
COVID-19/complicações , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Dor Abdominal/etiologia , Corticosteroides/uso terapêutico , Adulto , Febre/etiologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , República da Coreia , Choque/etiologia , Choque/terapia , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico
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