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

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.

Download Full-text

COVID-19 pneumonia successfully managed with high-flow nasal cannula in a 15-year-old boy

BMJ Case Reports ◽

10.1136/bcr-2020-239682 ◽

2021 ◽

Vol 14 (4) ◽

pp. e239682

Author(s):

GAP van Gorp ◽

PJLT Sanders ◽

DA van Waardenburg ◽

Monique Engel

Keyword(s):

Work Of Breathing ◽

Oxygen Demand ◽

Pediatric Intensive Care ◽

High Flow ◽

Nasal Cannula ◽

Respiratory Support ◽

Lower Airway ◽

Nasopharyngeal Swab ◽

High Flow Nasal Cannula ◽

Amoxicillin Clavulanic Acid

We report an otherwise healthy, fully immunised 15-year-old boy who was transferred to our Pediatric intensive care unit with 4 days of fever, dry cough, increased work of breathing and impending respiratory failure. Two days prior, amoxicillin/clavulanic acid was prescribed for lower airway symptoms resembling pneumonia. PCR of the nasopharyngeal swab revealed an active COVID-19 infection (Ct 19). The CT scan showed significant ground-glass opacities highly associated with COVID-19 (COVID-19 reporting and data system 4). Antibiotics were continued and chloroquine was given for 5 days. High-flow nasal cannula (HFNC) was started as respiratory support therapy with rapid decrease of tachypnoea and oxygen demand. HFNC was successfully stopped after 7 days. The patient made full clinical recovery. This case illustrates HFNC as a successful respiratory support therapy in a paediatric patient with an active COVID-19 pneumonia.

Download Full-text

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

BMJ Case Reports ◽

10.1136/bcr-2020-240845 ◽

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.

Download Full-text