key: cord-0963907-vqy5t343
authors: Diakite, Sarah; Bousdira, Nadine; Tachon, Guillaume; Ackermann, Felix; Groh, Matthieu; Rohmer, Julien
title: Regression of Coronary Aneurysms With Intravenous Immunoglobulins and Steroids for COVID-19 Adult Multisystem Inflammatory Syndrome
date: 2021-03-24
journal: JACC Case Rep
DOI: 10.1016/j.jaccas.2021.01.012
sha: 1d6251c1b8b39dd3515b14cce486756961f76e43
doc_id: 963907
cord_uid: vqy5t343

A multisystem inflammatory syndrome mimicking Kawasaki disease has been increasingly reported, mainly in children, in the context of coronavirus disease-2019 (COVID-19). We report on the first case of coronary aneurysm resolution after treatment with steroids and intravenous immunoglobulins in an adult patient with multisystem inflammatory syndrome temporally associated with COVID-19. (Level of Difficulty: Beginner.)

A 33-year-old man of sub-Saharan African origin was admitted to the intensive care unit for severe hypotension in the context of persistent fever, dyspnea, chest pain, and diarrhea. At referral to the intensive care unit, he presented with a blood pressure of 47/29 mm Hg, tachycardia (116 beats/min), the need for oxygen therapy (2 l/min by nasal cannula to maintain an oxygen saturation >94%), and hepatojugular reflux consistent with cardiogenic shock. Moreover, physical examination revealed bilateral conjunctivitis and cheilitis.

The patient had a medical history of hypertension.

Six weeks earlier, he had presented with a fever episode lasting for 5 days, along with myalgia, dysgeusia, and anosmia, which retrospectively was highly suggestive of coronavirus disease-2019 (COVID-19). However, as his condition was not worrying, and in line with the recommendations of the French health authorities at the time, he had not been tested for severe acute respiratory syndromecoronavirus-2 (SARS-CoV-2) infection.

To identify coronary aneurysms in case of unexplained severe heart failure in the context of acute or recent COVID-19 infection.

To consider prompt initiation of steroids and IVIG if such complications are seen. 

In the context of cardiac failure associated with fever and hypotension, septic shock was first considered, and broad-spectrum antibiotics were initiated.

The patient's laboratory results included leukocytosis (21 10 9 /l), normocytic anemia 

Two months later, while the patient felt fully recovered and his CRP level was <1 mg/L, a second 

Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort

Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 pandemic

Multisystem inflammatory syndrome in children in New York state

Multisystem inflammatory syndrome in children (MIS-C) in an adolescent that developed coronary aneurysms: a case report and review of the literature

Case series of multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection-United Kingdom and United States

Cardiogenic shock and hyperinflammatory syndrome in young males with COVID-19

COVID-19 acute myocarditis and multisystem inflammatory syndrome in adult intensive and cardiac care units

Acute and late coronary outcomes in 1073 patients with Kawasaki disease with and without intravenous g-immunoglobulin therapy

Management of multisystem inflammatory syndrome in children associated with COVID-19: a survey from the International Kawasaki Disease Registry

KEY WORDS coronary aneurysms, COVID-19, intravenous immunoglobulin, MIS COVID-19

Regression of Coronary Aneurysms in an Adult With

(arrows) during the acute phase (A), with partial regression after 2 months (B) and total regression after 5 months (C). Circumflex artery with multiple aneurysms (arrows) during the acute phase (D), with partial regression after 2 months (E) and total regression after 5 months (F). 

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.