Case of Kawasaki-like syndrome reported in adult with COVID-19

  • Am J Emerg Med

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.
  • Labs: 
    • 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.

Study design

  • Case report.
  • Funding: None.

Limitations

  • A single case report.