Para-aortic lymphadenopathy associated with adult COVID-19 multisystem inflammatory syndrome

Abstract

A 21-year-old woman arrived at the emergency department with dyspnoea, arterial hypotension and abdominal pain after 5 days with a influenza-like syndrome. SARS-CoV-2 was detected by reverse transcription PCR in a nasopharyngeal swab specimen. CT of the chest and abdomen with contrast demonstrated a minimal amount of free intraperitoneal fluid, gallbladder with wall oedema, multiple para-aortic lymph node and interlobular septal thickening with ground glass opacities on the lungs. No pleural effusion or thromboembolism. Early broad-spectrum antibiotics, high-flow nasal cannula and norepinephrine were started. She was successfully treated with intravenous immunoglobulin and pulse corticosteroid therapy with methylprednisolone. The patient was discharged home with complete resolution of her symptoms and returned to her previous health status.

Concomitant Cytomegalovirus Viraemia in Multisystem Inflammatory Syndrome in Adults (MIS-A) following COVID-19

“…The PET scan showed abdominal lymphadenopathies, as has been previously reported in other MIS-A cases [ 9 , 14 ]. The lymph node biopsy findings were of particular interest, as we were able to demonstrate the persistence of SARS-CoV-2 in macrophages.…”

The Impact of COVID-19 on the Cardiovascular Health of Emerging Adults Aged 18-25: Findings From a Scoping Review

“…In this review, 47 cases (mean age=21; 70% male) of emerging adults with cardiovascular complications in the context of confirmed or suspected hyperinflammatory syndromes and active or previous COVID-19 were identified. 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 If not concomitant COVID-19, previous infections typically occurred 3-8 weeks prior to onset of symptoms. 23 , 30 , 32 , 33 , 34 , 40 , 43 , 44 , 45 , 46 , 52 , 53 , 56 Alongside MIS-C/A, cardiovascular presentations/complications included ventricular dysfunction (n=33), tachycardia (n=28), hypotension (n=16), cardiogenic shock (n=14), cardiomyopathy (n=11), including myocarditis and pericarditis, valve insufficiency (n=4), atrial fibrillation (n=2), and non-ST-elevation myocardial infarction (n=2); refer to Supplemental Table S2 for additional case details.…”

“… 148 In the cohort study by Belay et al 148 , mainstay treatments for MIS included intravenous immunoglobulin (IVIG) and steroids. Across the 47 cases included in this review 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 , 70% (n=33) were treated with steroids (e.g. methylprednisolone, prednisolone, prednisone) and 62% (n=29) with IVIG.…”

Multisystem inflammatory syndrome in adults: Characteristics, treatment, and outcomes

“…Geographical distribution of reported cases of multisystem inflammatory syndrome in adults (as of October 26, 2022) 16,27–43 …”

“…[15][16][17]19,25,26 Many countries, including the United States, the UK, Italy, Israel, India, Canada, Japan, Pakistan, the United Arab Emirates, Croatia, Norway, France, Spain, Belgium, Portugal, South Africa, Lebanon, Switzerland, Thailand, Turkey, Austria, Cyprus, Sweden, Qatar, Oman, Brazil, South Korea, Germany, Uruguay, Mexico, Ireland, Malaysia, Australia, and Taiwan had reported the occurrence of MIS-A (Figure 1). 16,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] To help understand this rare but fatal complication, this review was conducted to provide updated and comprehensive information on MIS-A.…”