- Secondary inflammatory syndromes resembling Kawasaki disease (KD) may affect adults with COVID-19.
Why this matters
- In children infected with SARS-CoV-2, cases of a KD-like multisystem inflammatory syndrome in children (MIS-C) have been reported.
- The phenomenon is apparently not limited to pediatric patients.
- A 36-year-old Hispanic woman presented with subjective fever, abdominal pain, vomiting, and diarrhea for 1 week, and rash and arthralgias for 2 days.
- Past medical history: unremarkable.
- Vital signs: febrile, tachycardic, tachypneic, hypotensive.
- Examination revealed classic KD:
- Nonexudative conjunctivitis,
- Mucositis and cracked lips,
- Edema of hands and feet,
- Reddened palms,
- Diffuse maculopapular rash, and
- Cervical lymphadenopathy.
- Leukocytosis, neutrophilia, normocytic anemia.
- Sodium: 115 mmol/L.
- Elevated liver enzymes, hyperbilirubinemia.
- C-reactive protein: 30 mg/dL.
- D-dimer: 652 ng/mL.
- COVID-19 testing: positive PCR, positive IgG, negative IgM.
- CT: normal lung parenchyma; gallbladder thickening and area of colitis consistent with KD and MIS-C.
- Echocardiogram: ejection fraction 65%; moderate tricuspid regurgitation.
- Presentation suspicious for KD shock syndrome.
- Treatment: fluid resuscitation, aspirin, intravenous Ig, methylprednisolone, then steroid taper.
- Within 1 day, vitals normalized; labs improved over 6 days.
- Case report.
- Funding: None.
- A single case report.