A Young Adult with COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C)-like Illness: A Case Report

Abstract

Background: 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 one 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.Conclusion: MIS-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.

Rare presentation of multisystem inflammatory syndrome in an adult associated with SARS-CoV-2 infection: unilateral neck swelling

“… 3 Another two cases described young adults who presented with multisystem inflammatory syndrome similar to MIS-C or Kawasaki’s disease. 6 7 Among these cases, all patients had illness severe enough to require hospitalisation. The most common initial presentations that led patients to seek medical attention were fever of 38°C or higher for at least 24 hours, extreme malaise and gastrointestinal symptoms, including abdominal pain, vomiting and diarrhoea.…”

“… 3 In late 2020, two more case reports of a 25-year-old and an 18-year-old were published. 6 7 While MIS-A is emerging as a recognised and suspected diagnosis, there is currently a lack of diagnostic and therapeutic guidance given the novelty of the syndrome and THE lack of large-scale data on the phenomenon. Here, we present the case of a 28-year-old patient who presented initially with unilateral neck swelling a month after a positive COVID-19 test, with the purpose of adding to the literature on the variable presentation and clinical courses of MIS-A.…”

Two adult cases of multisystem inflammatory syndrome associated with SARS-CoV-2

“…Skin involvement can be a helpful clue to clinicians when diagnosing MIS. 4,5 Few detailed dermatologic descriptions exist but include generalized erythematous or violaceous maculopapular eruption, erythema multiforme-like eruption, palmoplantar desquamation, conjunctival injection, strawberry tongue, acral or facial swelling, and mucositis. 2,3,6,7 We report 2 patients with MIS-A, who initially presented with exanthema, with one further developing acral desquamation and conjunctival involvement.…”

Multisystem inflammatory syndrome in an adult after SARS-CoV-2 infection

“…He received IV immunoglobulin 1 g/kg/d for 2 days and oral ASA 325 mg/d until clinical resolution, as evidenced by absence of fevers and normal C-reactive protein. This treatment was based on expert opinion and up-to-date evidence on Kawasaki disease and MIS-C. 2,6,8,[11][12][13] The American College of Rheumatology recommends a step-wise approach to immunomodulatory treatment in MIS-C with IV immunoglobulin or glucocorticoids considered as first-tier agents, 11 and the American Heart Association recommends high-dose immunoglobulin (2 g/kg) as a single IV dose for treatment of Kawasaki disease. 2 Although the patient did not have clinically significant thrombocytosis, we prescribed a short course of high-dose ASA to prevent thrombosis and coronary artery aneurysms.…”