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

2021 ◽  
Vol 14 (7) ◽  
pp. e240845
Author(s):  
Eamonn Faller ◽  
Rachel Barry ◽  
Owen O'Flynn ◽  
Peter Kearney ◽  
Corinna Sadlier
Keyword(s):  
Troponin I ◽  
High Sensitivity ◽  
High Flow ◽  
Good Recovery ◽  
Erythematous Rash ◽  
Respiratory Compromise ◽  
Reverse Transcription Pcr ◽  
History Of ◽  
Stool Samples ◽  
Inflammatory Syndrome

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.

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

2021 ◽  
Vol 14 (12) ◽  
pp. e246884
Author(s):  
Victor Carvalho ◽  
Paula H Damasco ◽  
Thiago S Mello ◽  
Bruno Gonçalves
Keyword(s):  
Complete Resolution ◽  
High Flow ◽  
Nasopharyngeal Swab ◽  
Minimal Amount ◽  
High Flow Nasal Cannula ◽  
Reverse Transcription Pcr ◽  
Aortic Lymph Node ◽  
Inflammatory Syndrome ◽  
Swab Specimen ◽  
Interlobular Septal Thickening

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.

scholarly journals High Sensitivity Troponin in Infarcted Patients with History of Myocardial In-farction

2019 ◽  
pp. 1-5
Author(s):  
Orlando Victorino de Moura Junior ◽  
Arthur Augusto Souza Bordin ◽  
Sibele Sauzem Milano ◽  
Gustavo Lenci Marques
Keyword(s):  
Myocardial Infarction ◽  
Troponin I ◽  
High Sensitivity ◽  
Serum Levels ◽  
Previous Myocardial Infarction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
High Sensitivity Troponin ◽  
St Segment ◽  
History Of

Design of the Study: Historical Cohort. Objectives: This study aimed to verify which risk factors contribute to increase hs-cTnI in patients with Myocardial Infarcion with ST segment elevation, to ana-lyze which prognostic impacts it may have and to evaluate troponin levels in pa-tients that had previous acute myocardial infarction and assess how this com-pared to patients without previous history of an acute event. Methodology: It was assessed medical records of patients admitted in the Cor-onary Unit of the Hospital de Clínicas (HC-UFPR) in Curitiba, South of Brazil, diagnosed with ST segment elevation Myocardial Infarction and whose serum levels of high sensitivity troponin I (hs-cTnI) were collected at admission moment. The select data were: gender, age, high blood pressure, smoking, diabetes, previous myocardial infarction, dyslipidemia and serum levels of high sensitivity troponin I. For prognostic proposes, it was analysed intra-hospital death and ventricular function, based on left ventricular ejection fraction. Findings: Patients admitted with previous myocardial infarction had lower levels of hs-TnI. Gender, age, presence of high blood pressure, tabagism, diabetes and dyslipidemia didn’t reveal correlation with troponin values, allowing the in-ference that high sensitivity troponin values at first presentation of these patients have no direct relation to these variables. Regarding prognosis, levels of high sensitivity troponin could not be associated to mortality or ventricular malfunction. Conclusions: At admission, high-sensitivity troponin I levels were lower in pa-tients with prior myocardial infarction. Relevance: This work correlates the values of the high-sensitivity troponin of    patients with ST segment Elevation Myocardial Infarction to cardiovascular risks factors and to the prognosis of these patients. This approach is not found in cur-rent medical literature, whose works mainly relates to acute events.

scholarly journals Cardiovascular outcomes in systemic sclerosis with abnormal cardiovascular MRI and serum cardiac biomarkers

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e001689
Author(s):  
Raluca B Dumitru ◽  
Lesley-Anne Bissell ◽  
Bara Erhayiem ◽  
Ananth Kidambi ◽  
Ana-Maria H Dumitru ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Troponin I ◽  
Systolic Dysfunction ◽  
Extracellular Volume ◽  
High Sensitivity ◽  
Outcome Data ◽  
Cardiac Biomarkers ◽  
Diffuse Fibrosis ◽  
History Of ◽  
Standard Serum

ObjectivesTo explore the prognostic value of subclinical cardiovascular (CV) imaging measures and serum cardiac biomarkers in systemic sclerosis (SSc) for the development of CV outcomes of primary heart involvement (pHI).MethodsPatients with SSc with no clinical SSc-pHI and no history of heart disease underwent cardiovascular magnetic resonance (CMR) imaging, and measurement of serum high-sensitivity-troponin I (hs-TnI) and N-terminal-pro-brain natriuretic peptide (NT-proBNP). Follow-up clinical and CV outcome data were recorded. CV outcomes were defined as myocarditis, arrhythmia and/or echocardiographic functional impairment including systolic dysfunction and/or diastolic dysfunction.ResultsSeventy-four patients with a median (IQR) age of 57 (49, 63) years, 32% diffuse cutaneous SSc, 39% interstitial lung disease, 30% Scl70+ were followed up for median (IQR) 22 (15, 54) months. Ten patients developed CV outcomes, comprising one patient with myocarditis and systolic dysfunction and nine arrhythmias: three non-sustained ventricular tachycardia and six supraventricular arrhythmias. The probability of CV outcomes was considerably higher in those with NT-proBNP >125 pg/mL versus normal NT-proBNP (X2=4.47, p=0.035). Trend for poorer time-to-event was noted in those with higher extracellular volume (ECV; indicating diffuse fibrosis) and hs-TnI levels versus those with normal values (X2=2.659, p=0.103; X2=2.530, p=0.112, respectively). In a predictive model, NT-proBNP >125 pg/mL associated with CV outcomes (OR=5.335, p=0.040), with a trend observed for ECV >29% (OR=4.347, p=0.073).ConclusionThese data indicate standard serum cardiac biomarkers (notably NT-proBNP) and CMR indices of myocardial fibrosis associate with adverse CV outcomes in SSc. This forms the basis to develop a prognostic model in larger, longitudinal studies.

scholarly journals Kawasaki-like Syndrome as an Emerging Complication of SARS-CoV-2 Infection in Young Adults

2020 ◽  
Author(s):  
César Burgi Vieira ◽  
Ana Teresa Ferreira ◽  
Filipa Botelho Cardoso ◽  
Jorge Pelicano Paulos ◽  
Nuno Germano
Keyword(s):  
Abdominal Pain ◽  
Cardiac Dysfunction ◽  
High Sensitivity ◽  
Serum Levels ◽  
Good Clinical Response ◽  
Younger Patients ◽  
History Of ◽  
Erythematous Skin ◽  
Inflammatory Syndrome ◽  
Low Ejection Fraction

Background: Kawasaki-like syndrome occurring in children during the COVID-19 pandemic has been labelled multisystem inflammatory syndrome in children (MIS-C) by the CDC and paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) by the ECDC.  Case report: We report the case of an 18-year-old male patient presenting with a 72-hour history of abdominal pain, fever, erythematous skin rash, vomiting and diarrhoea. Examination showed he also had shock and he was first thought to have oedematous cholecystitis. SARS-CoV-2 infection was also diagnosed. He was admitted to the ICU, and echocardiography showed cardiac dysfunction, with a low ejection fraction and low cardiac index. High-sensitivity troponin serum levels were elevated. The patient received inotropic and vasopressor support. As he fulfilled several criteria for MIS-C/PIMS-TS, he was administered acetylsalicylic acid, corticosteroids and immunoglobulin, with a good clinical response.<br /> Conclusion: This case emphasizes how this severe presentation of COVID-19 can easily be misdiagnosed if the clinician is less aware of this syndrome in younger patients.

High-sensitivity cardiac troponin I in women with a history of early-onset preeclampsia

2020 ◽  
Vol 38 (10) ◽  
pp. 1948-1954
Author(s):  
Hella E.C. Muijsers ◽  
Dirk Westermann ◽  
Anna Birukov ◽  
Olivier W.H. van der Heijden ◽  
José T. Drost ◽  
...  
Keyword(s):  
Early Onset ◽  
Cardiac Troponin ◽  
Troponin I ◽  
High Sensitivity ◽  
Cardiac Troponin I ◽  
History Of ◽  
Early Onset Preeclampsia

scholarly journals A 23-Year-Old Man With Multisystem Inflammatory Syndrome After Mild COVID-19

2020 ◽  
Vol 8 ◽  
pp. 232470962097420
Author(s):  
Alexander C. Razavi ◽  
Jonathan L. Chang ◽  
Aimee Sutherland ◽  
Anjali Niyogi ◽  
Geraldine E. Ménard
Keyword(s):  
Troponin I ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Nasopharyngeal Swab ◽  
Ventricular Ejection Fraction ◽  
St Segment ◽  
History Of ◽  
Polymerase Chain ◽  
Inflammatory Syndrome

We present the case of a young obese patient with recent COVID-19 (coronavirus disease 2019) who developed multisystem inflammatory syndrome (MIS) 1 month after spontaneous resolution. A 23-year-old African American man was admitted with a 1-week history of worsening fatigue, myalgias, headache, and dyspnea. Nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative by polymerase chain reaction; however, the patient was febrile and had leukocytosis, elevated troponin I, transaminitis, and acute kidney injury. Bedside echocardiogram showed decreased left ventricular ejection fraction (40% to 45%) and global hypokinesis in the setting of a type II non-ST segment myocardial infarction. Despite being on broad spectrum antibiotic therapy, the patient’s clinical condition continued to worsen. The patient was then empirically treated for MIS with intravenous immunoglobulin and methylprednisolone, which led to a rapid resolution of fever and laboratory abnormalities. This case highlights that MIS associated with COVID-19 may present in patients above the age of 21 years and can occur with a delayed onset after mild illness in those with no previous oxygen requirement or hospitalization during SARS-CoV-2 infection.

scholarly journals MULTISYSTEM INFLAMMATORY SYNDROME IN A CHILD ASSOCIATED WITH CORONAVIRUS DISEASE 19 IN THE BRAZILIAN AMAZON: FATAL OUTCOME IN AN INFANT

2020 ◽  
Vol 38 ◽  
Author(s):  
Emmerson Carlos Franco de Farias ◽  
Maria Cleonice Aguiar Justino ◽  
Mary Lucy Ferraz Maia Fiuza de Mello
Keyword(s):  
Troponin I ◽  
Fatal Outcome ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Extreme Prematurity ◽  
Low Weight ◽  
History Of ◽  
Special Concern ◽  
Inflammatory Syndrome ◽  
D Dimer

ABSTRACT Objective: Recently, there have been reports of children with severe inflammatory syndrome and multiorgan dysfunction associated with elevated inflammatory markers. These cases are reported as presenting the Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. In this study, we describe with parental permission a case of MIS-C in an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Case description: A seven-month-old infant, with SARS-CoV-2 infection and a history of extreme preterm birth and very low weight at birth, with an initial course of mild respiratory symptoms and abrupt progression to vasoplegic shock, myocarditis and hyperinflammation syndrome, shown by high levels of troponin I, ferritin, CRP, D-dimer and hypoalbuminemia. Despite the intensive care provided, the child developed multiple organ dysfunction and died. Comments: Patients with a history of extreme prematurity may present with MIS-C in the presence of COVID-19 and are a group of special concern.

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