Abstract
BackgroundA healthy 25-year-old woman developed COVID-19 disease with clinical characteristics resembling Multisystem Inflammatory Syndrome in Children (MIS-C), a rare form of COVID-19 described primarily in children under 21 years of age.Case presentationThe patient presented with 1 week of weakness, dyspnea, and low-grade fevers, followed by mild cough, sore throat, vomiting, diarrhea, and lymph node swelling. She was otherwise healthy, with no prior medical history. Her hospital course was notable for profound acute kidney injury, leukocytosis, hypotension, and cardiac dysfunction requiring ICU admission and vasopressor support. MIS-C-like illness secondary to COVID-19 was suspected due to physical exam findings of conjunctivitis, mucositis, and shock. She improved following IVIG, aspirin, and supportive care, and was discharged on hospital day 5.ConclusionMIS-C-like illness should be considered in adults presenting with atypical clinical findings and concern for COVID-19. Further research is needed to support the role of IVIG and aspirin in this patient population.
Highlights
A healthy 25-year-old woman developed COVID-19 disease with clinical characteristics resembling Multisystem Inflammatory Syndrome in Children (MIS-C), a rare form of COVID-19 described primarily in children under 21 years of age.Case presentation: The patient presented with 1 week of weakness, dyspnea, and low-grade fevers, followed by mild cough, sore throat, vomiting, diarrhea, and lymph node swelling
Due to concern for inflammatory multi-system organ involvement similar to that seen in MIS-C, and risk of progression to more florid cardiac involvement, a riskbenefit discussion was held with the patient regarding treatment with intravenous immunoglobulin (IVIG), including potential risk of hypercoagulability [6]. She was treated with IVIG 2 g/kg split between hospital days 2 and 3 to reduce risk for thromboembolic and renal toxicities, along with aspirin 325 mg daily for 7 days, based on treatment courses suggested for pediatric patients with MIS-C or Kawasaki disease [7–9]
The Centers for Disease Control and Prevention (CDC)‘s case definition for MIS-C is (1) an individual less than 21 years of age presenting with fever, (2) laboratory evidence of inflammation by one or more markers, (3) evidence of clinically severe illness requiring hospitalization, with greater than 2 organ systems involved, (4) no other plausible alternative diagnosis, and (5) SARSCoV-2 infection confirmed by RT-Polymerase chain reaction (PCR), serology, or antigen testing
Summary
A healthy 25-year-old woman developed COVID-19 disease with clinical characteristics resembling Multisystem Inflammatory Syndrome in Children (MIS-C), a rare form of COVID-19 described primarily in children under 21 years of age.Case presentation: The patient presented with 1 week of weakness, dyspnea, and low-grade fevers, followed by mild cough, sore throat, vomiting, diarrhea, and lymph node swelling. Conclusion: MIS-C-like illness should be considered in adults presenting with atypical clinical findings and concern for COVID-19. When the epidemic began in China in late December 2019, case reports of pediatric illness were relatively rare, and almost all children had mild clinical courses.
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