Adult presentation of multisystem inflammatory syndrome (MIS) associated with recent COVID-19 infection: lessons learnt in timely diagnosis and management

Multisystem inflammatory syndrome in adults (MIS-A) is an uncommon and under-recognised postinfectious manifestation that presents 4–6 weeks after COVID-19 infection. Patients affected tend to be young or middle-aged, from ethnic minority backgrounds and previously healthy. In addition to high fever and myalgia, there are a myriad of extrapulmonary symptoms and signs, including cardiac, gastrointestinal, neurological and dermatological involvement. Cardiovascular shock and markedly raised inflammatory markers are prominent features, while significant hypoxia is uncommon. Patients respond well to corticosteroid therapy, but failure of clinicians to recognise this recently identified phenomenon, which can mimic common conditions including sepsis, could delay diagnosis and treatment. Here we present a case of MIS-A in an adult woman, compare her presentation and management with other similar case reports, and reflect on how clinicians can learn from our experiences.

An Atypical Adult Presentation of Acute Clonidine Intoxication: A Case Report

Clonidine is drug which was initially used as a nasal decongestant and now commonly used in the treatment of several conditions both in adults and children. Even though there is no minimum toxic dose for this drug, low-dose clonidine poisonings are commonly seen in children. Accidental ingestion of this drug or transdermal exposure can cause altered sensorium, hypertension, hypotension and bradycardia because of various mechanism of action. Key words: Clonidine, intoxication, hypotension, miosis.

Partial congenital arrhinia: never seen before adult presentation

Background Arrhinia is defined as the partial or complete absence of the nasal structures. It is a defect of embryonal origin and can be seen in association with other craniofacial anomalies, central nervous system anomalies, absence of paranasal sinuses, and other palatal and ocular abnormalities. Very few patients with arrhinia have been reported so far in the history of modern medicine. Case report This study reports an adult patient with congenital partial arrhinia and reviews the literature along with the embryological basis of such a rare disease. Conclusion Arrhinia is a medical condition with scarce documentation in the literature. This article presents the clinical as well as radiological features of this rare entity.

ADULT PRESENTATION OF HIRSCHSPRUNG’S DISEASE; A CASE REPORT

Young patients presenting with chronic constipation and failure to thrive, should be promptly investigated and looked upon for late presentation of congenital diseases like Hirschsprung disease (HD). This case is reported to highlight rare case of adult presentation of HD who presented to emergency department with complaints of lower abdominal pain, flatulence and lethargy. Considering the findings of CT scan suspicion of Adult presentation of HD was given and lateral biopsy confirmed the diagnosis.

A Left Pulmonary Artery Sling in an Asymptomatic Adult Patient, A Case Report and Review of Literature

Pulmonary artery sling (PAS) is a rare congenital vascular anomaly. Ninety percent of patients with PAS have respiratory distress and need surgical correction. Asymptomatic adult presentation of PAS is rare. We report the case of a 56-year-old female with an asymptomatic left pulmonary artery sling.

Late adult presentation of ALCAPA syndrome: need for a new clinical classification? A case report and literature overview

Background Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) is a very uncommon congenital coronary artery anomaly, most commonly presenting in early infancy. Late adult presentation of ALCAPA syndrome is extremely rare. Case summary We present a case of a 76-year-old patient with first presentation of ALCAPA. The coronary anomaly was first diagnosed during elective coronary angiography. The case was discussed at the Heart Team meeting and as the patient was asymptomatic, had good coronary collateral circulation, a medical treatment strategy was chosen and the patient was discharged in a good physical condition. During 3 years of follow-up, the patient has experienced no cardiovascular complications. Discussion We hereby also discuss briefly the clinical presentation, epidemiology, diagnostics and treatment options for adults with newly diagnosed ALCAPA and discuss the need for a new clinical classification. Only a few cases have been published of septuagenarians or octogenarians with first presentation of ALCAPA. To our knowledge, the patient presented in our case was one of the least symptomatic patients during her eight decades of life.