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COVID-19 associated Kawasaki-like multisystem inflammatory disease in an adult.
Am J Emerg Med. 2020 Jun 25 [Online ahead of print]AJ

Abstract

Recent reports have described a secondary Multisystem Inflammatory Syndrome in Children (MIS-C) after a prior COVID-19 infection that often has features of Kawasaki disease (KD). Here, we report the case of a 36-year-old woman who presented to the emergency department hypotensive and tachycardic after 1 week of fevers, abdominal pain, vomiting and diarrhea, and was found to have the classic phenotype of complete Kawasaki's Disease including nonexudative conjunctivitis, cracked lips, edema of the hands and feet, palmar erythema, a diffuse maculopapular rash, and cervical lymphadenopathy. Initial laboratory studies were significant for hyponatremia, elevated liver function tests including direct hyperbilirubinemia, and leukocytosis with neutrophilia. Imaging revealed mild gallbladder wall edema, a small area of colitis, and small pleural effusion. She was treated for Kawasaki Disease Shock Syndrome (KDSS) with pulse dose solumedrol, IVIG, and aspirin with near resolution of symptoms and normalization of vital signs within 1 day and subsequent improvement in her laboratory abnormalities. She was later found to be COVID-19 IgG positive, suggesting past exposure. This case represents an early report of a KD-like illness in an adult with serologic evidence of a previous COVID-19 infection, similar to MIS-C. It suggests that the virulent strain of SARS-CoV-2 appears to cause a post-infectious inflammatory syndrome similar to KD in adults, as well as children. Our understanding of the myriad of COVID-19 symptoms and sequelae is rapidly evolving. We recommend physicians remain vigilant for inflammatory syndromes that mimic KD/KDSS which may warrant prompt treatment with IVIG and steroids.

Authors+Show Affiliations

Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, United States of America.Division of Pulmonary and Critical Care, Maimonides Medical Center, Brooklyn, NY, United States of America.Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, United States of America.Division of Pediatric Rheumatology, New York University Langone Medical Center, New York, NY, United States of America.Division of Rheumatology, Maimonides Medical Center, Brooklyn, NY, United States of America. Electronic address: JScheers-Masters@maimonidesmed.org.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32631771

Citation

Sokolovsky, Sabrina, et al. "COVID-19 Associated Kawasaki-like Multisystem Inflammatory Disease in an Adult." The American Journal of Emergency Medicine, 2020.
Sokolovsky S, Soni P, Hoffman T, et al. COVID-19 associated Kawasaki-like multisystem inflammatory disease in an adult. Am J Emerg Med. 2020.
Sokolovsky, S., Soni, P., Hoffman, T., Kahn, P., & Scheers-Masters, J. (2020). COVID-19 associated Kawasaki-like multisystem inflammatory disease in an adult. The American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2020.06.053
Sokolovsky S, et al. COVID-19 Associated Kawasaki-like Multisystem Inflammatory Disease in an Adult. Am J Emerg Med. 2020 Jun 25; PubMed PMID: 32631771.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 associated Kawasaki-like multisystem inflammatory disease in an adult. AU - Sokolovsky,Sabrina, AU - Soni,Parita, AU - Hoffman,Taryn, AU - Kahn,Philip, AU - Scheers-Masters,Joshua, Y1 - 2020/06/25/ PY - 2020/06/07/received PY - 2020/06/18/accepted PY - 2020/7/8/entrez PY - 2020/7/8/pubmed PY - 2020/7/8/medline KW - COVID-19 KW - Kawasaki Disease Shock Syndrome KW - Kawasaki disease KW - Multisystem Inflammatory Syndrome JF - The American journal of emergency medicine JO - Am J Emerg Med N2 - Recent reports have described a secondary Multisystem Inflammatory Syndrome in Children (MIS-C) after a prior COVID-19 infection that often has features of Kawasaki disease (KD). Here, we report the case of a 36-year-old woman who presented to the emergency department hypotensive and tachycardic after 1 week of fevers, abdominal pain, vomiting and diarrhea, and was found to have the classic phenotype of complete Kawasaki's Disease including nonexudative conjunctivitis, cracked lips, edema of the hands and feet, palmar erythema, a diffuse maculopapular rash, and cervical lymphadenopathy. Initial laboratory studies were significant for hyponatremia, elevated liver function tests including direct hyperbilirubinemia, and leukocytosis with neutrophilia. Imaging revealed mild gallbladder wall edema, a small area of colitis, and small pleural effusion. She was treated for Kawasaki Disease Shock Syndrome (KDSS) with pulse dose solumedrol, IVIG, and aspirin with near resolution of symptoms and normalization of vital signs within 1 day and subsequent improvement in her laboratory abnormalities. She was later found to be COVID-19 IgG positive, suggesting past exposure. This case represents an early report of a KD-like illness in an adult with serologic evidence of a previous COVID-19 infection, similar to MIS-C. It suggests that the virulent strain of SARS-CoV-2 appears to cause a post-infectious inflammatory syndrome similar to KD in adults, as well as children. Our understanding of the myriad of COVID-19 symptoms and sequelae is rapidly evolving. We recommend physicians remain vigilant for inflammatory syndromes that mimic KD/KDSS which may warrant prompt treatment with IVIG and steroids. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/32631771/COVID-19_associated_Kawasaki-like_multisystem_inflammatory_disease_in_an_adult L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(20)30542-8 DB - PRIME DP - Unbound Medicine ER -
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