Adult Inflammatory Multi-System Syndrome Mimicking Kawasaki Disease in a Patient With COVID-19

Malangu, Boniface; Quintero, Javier A.; Capitle, Eugenio

doi:10.7759/cureus.11750

Cited by 10 publications

(12 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 221 patients with MIS-A were identified: 102 were from the CDC’s MIS-C surveillance system, of whom 55 were described in a recent publication 3 ; 20 were from voluntary reports to the CDC, of whom 9 were included in a recent publication 2 ; and 99 were from case reports published in the literature. 2 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , …”

Section: Resultsmentioning

confidence: 99%

“…In total, 449 relevant articles were identified, and 86 were selected for in-depth review; of these, 60 had data for patients with MIS-A. 2 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 Figure 1 summarizes...…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults

et al. 2021

View full text Add to dashboard Cite

Key Points Question What are the clinical characteristics of multisystem inflammatory syndrome in adults (MIS-A)? Findings This systematic review of patients with MIS-A reported in the literature and to the US Centers for Disease Control and Prevention identified 221 patients worldwide. The syndrome presented approximately 4 weeks after acute COVID-19 with hyperinflammation and extrapulmonary multiorgan involvement that may be difficult to discern from acute biphasic COVID-19 and postacute sequelae of SARS-CoV-2 infection. Meaning These findings suggest that MIS-A occurs in the postacute COVID-19 period with a heterogeneous clinical presentation likely owing to a dysregulated immune response.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In SARS-CoV-2 infected hamsters, vascular alterations were most prominent at 3 and 6 dpi. At these days, vasculopathy especially affected small and medium-sized vessels, resembling vascular alterations described for the Kawasaki-like syndrome of patients suffering from SARS-CoV-2 infection [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Vascular Inflammation Is Associated with Loss of Aquaporin 1 Expression on Endothelial Cells and Increased Fluid Leakage in SARS-CoV-2 Infected Golden Syrian Hamsters

Allnoch¹,

Beythien²,

Leitzen³

et al. 2021

Viruses

View full text Add to dashboard Cite

Vascular changes represent a characteristic feature of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection leading to a breakdown of the vascular barrier and subsequent edema formation. The aim of this study was to provide a detailed characterization of the vascular alterations during SARS-CoV-2 infection and to evaluate the impaired vascular integrity. Groups of ten golden Syrian hamsters were infected intranasally with SARS-CoV-2 or phosphate-buffered saline (mock infection). Necropsies were performed at 1, 3, 6, and 14 days post-infection (dpi). Lung samples were investigated using hematoxylin and eosin, alcian blue, immunohistochemistry targeting aquaporin 1, CD3, CD204, CD31, laminin, myeloperoxidase, SARS-CoV-2 nucleoprotein, and transmission electron microscopy. SARS-CoV-2 infected animals showed endothelial hypertrophy, endothelialitis, and vasculitis. Inflammation mainly consisted of macrophages and lower numbers of T-lymphocytes and neutrophils/heterophils infiltrating the vascular walls as well as the perivascular region at 3 and 6 dpi. Affected vessels showed edema formation in association with loss of aquaporin 1 on endothelial cells. In addition, an ultrastructural investigation revealed disruption of the endothelium. Summarized, the presented findings indicate that loss of aquaporin 1 entails the loss of intercellular junctions resulting in paracellular leakage of edema as a key pathogenic mechanism in SARS-CoV-2 triggered pulmonary lesions.

show abstract

“…Nasopharyngeal swab samples were tested for SARS-CoV-2 PCR yielded negative results, and the blood sample tested for SARS CoV-2 IgM + IgG antibody yielded positive results. There was no pathological sign on chest CT. A little amount of free liquid was detected in the pelvic region and among some parts of small intestine on abdomen CT. After obtaining blood, urine, and stool samples for cultures, Hékimian et al [12] Hékimian et al [12] Hékimian et al [12] Hékimian et al [12] Hékimian et al [12] Hékimian et al [12] Hékimian et al [12] Moghadam et al [13] Age ( [16] Ahsan et al [17] Malangu et al [18] Gulersen et al [19] Vieira et al [5] Razavi et al [20] Age ( Riollano-Cruz et al [21] Riollano-Cruz et al [21] Othenin-Girard [22] Parker [23] Parker [23] Kaushik et al [24] Kaushik et al [24] Chérif et al [25] Downing et al [26] Shan et al [27] Age empirical ceftriaxone 2 gr/day was started. On the follow up, hypotension, tachycardia, and hypoxia developed on the first day of treatment, and procalcitonin, troponin, and pro-BNP levels were found increased.…”

Section: Casementioning

confidence: 99%

Multiple system inflammatory syndrome associated with SARS-CoV-2 infection in an adult and an adolescent

et al. 2021

View full text Add to dashboard Cite

Multisystem inflammatory syndrome in adults (MIS-A) is a new syndrome related with COVID-19. A case-based review was performed to present real-life experiences in terms of main findings and treatment options. We described two cases with the diagnosis of MIS and searched the literature to review all reported ≥ 18-year-old cases. The PubMed, Scopus, and Web of Science databases were searched. All relevant articles from January 2020 to February 2021 were reviewed. An adolescent and an adult patient (18 and 40 years-old, respectively) with the diagnosis of MIS were presented. Both had the consistent clinical findings with the case definition criteria. Although steroid, intravenous immunoglobulin (IVIG) and supportive care treatments have been suggested in the literature, there exists no treatment guideline for MIS-A. The clinical and laboratory findings of the patients progressively improved with the implementation of the IVIG and the pulse steroid treatments. A total of 51 cases (≥ 18 years-old) with MIS were analyzed. Mean age was 29.4 ± 10 years. Fever (80.4%), gastrointestinal (72.5%), and respiratory symptoms (54.9%) were the predominant symptoms. Cardiovascular abnormalities were the most frequent reported findings (82.4%, 42/51). The dermatological and conjunctival findings were reported in 39.2% and 35.3% of the patients, respectively. The increased level of inflammatory biomarkers was remarkable. Most of the patients were treated successfully with steroid and IVIG. Clinicians managing adult patients should keep in mind the development risk of MIS related with SARS-CoV-2 infection to perform necessary interventions properly without delay. IVIG and pulse steroid treatments are the effective options on clinical improvement.

show abstract

Adult Inflammatory Multi-System Syndrome Mimicking Kawasaki Disease in a Patient With COVID-19

Cited by 10 publications

References 11 publications

Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults

Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults

Vascular Inflammation Is Associated with Loss of Aquaporin 1 Expression on Endothelial Cells and Increased Fluid Leakage in SARS-CoV-2 Infected Golden Syrian Hamsters

Multiple system inflammatory syndrome associated with SARS-CoV-2 infection in an adult and an adolescent

Contact Info

Product

Resources

About