Kawasaki-like multisystem inflammatory syndrome associated with SARS-CoV-2 infection in an adult

Abstract

Kawasaki-like hyperinflammatory syndrome has been widely described as a manifestation of SARS-CoV-2 infection in paediatric patients. We report a compatible presentation and suggest that physicians consider the potential for this multisystem inflammatory syndrome to occur in adults. A 23-year-old man presented to hospital with a 4-day history of vomiting, diarrhoea, dry cough, fever and a blanching erythematous rash on hands, feet and buttocks. He was otherwise fit and healthy. On day 3 of admission, marked bilateral conjunctivitis developed and high sensitivity troponin I increased significantly, followed by acute respiratory compromise requiring high-flow nasal oxygen therapy. Transthoracic echocardiogram on day 5 showed severe global hypokinesis of the left ventricle with an ejection fraction of 22%. SARS-CoV-2 was not detected by reverse transcription PCR on nasopharyngeal swabs, sputum or stool samples, however, SARS-CoV-2 antibody was positive. The patient’s syndrome resolved and cardiomyopathy reversed completely with supportive measures. He has since made a good recovery.

Mucocutaneous manifestations of COVID-19-related multisystem inflammatory syndrome in adults: an update

“…An interesting KD‐like presentation was reported in which blanchable erythematous rash on the hands, feet and buttocks were the only skin features; the condition resolved with supportive treatment. 15 An Italian study reported that the most common signs in their cohort were polymorphic rash, bilateral nonexudative conjunctivitis, and erythema of the hands and feet. 16 Dabas et al .…”

“…An interesting KD-like presentation was reported in which blanchable erythematous rash on the hands, feet and buttocks were the only skin features; the condition resolved with supportive treatment. 15 An Italian study reported that the most common signs in their cohort were polymorphic rash, bilateral nonexudative conjunctivitis, and erythema of the hands and feet. 16 Dabas et al reported a 22-year-old Indian man with raised SARS-CoV-2 antibody level (but negative results on reverse transcription PCR), who presented with bilateral nonexudative conjunctival erythema, hyperpigmented fissured lips, generalized erythema with well-defined hyperpigmented macules on the face, trunk and extremities, and oedema of the hands and feet.…”

“…described a case of a middle‐aged Indian woman (initially suspected to have a drug reaction) with MIS‐A having prominent KD‐like mucocutaneous features: morbilliform rash on the limbs and trunk (appeared within a day of fever development, associated with unilateral cervical lymphadenopathy), strawberry tongue, crusting of the lips, palmoplantar erythema and conjunctivitis, all of which resolved with steroids. An interesting KD‐like presentation was reported in which blanchable erythematous rash on the hands, feet and buttocks were the only skin features; the condition resolved with supportive treatment 15 . An Italian study reported that the most common signs in their cohort were polymorphic rash, bilateral nonexudative conjunctivitis, and erythema of the hands and feet 16 .…”

Multisystem inflammatory syndrome in an adult (MIS-A) due to SARS-CoV-2 infection presenting to a South African hospital

“…PCR for SARS-CoV-2 is frequently negative in such patients and positive serological testing suggests evidence of recent infection,2 11 12 though persistent PCR positivity in these patients is well described 3 8 9 13. A similar syndrome has subsequently been recognised in adults7 8 11 13–21 and a case definition for multisystem inflammatory syndrome in adults (MIS-A) was published by the Centers for Disease Control and Prevention (CDC) in May 2021 22. However, few cases of MIS-A have been reported in Africa, where unique challenges exist which may limit the recognition and prompt appropriate management of this life-threatening condition.…”

Different rates of conjunctivitis in COVID-19 eastern and western hospitalized patients: a meta-analysis

“…Thus, conjunctivitis could represent a sign of a systemic disease and a warning sign of poor outcome consequent to the systemic inflammation. This hypothesis may be supported by the multisystem inflammatory syndrome in young with COVID-19, where conjunctivitis has been described as a sign of a storm of cytokines and inflammatory molecules [ 14 , 15 ].…”