key: cord-1035936-s35vzeag
authors: Kobe, Hiroshi; Ito, Akihiro; Ishida, Tadashi
title: COVID‐19‐induced adult multisystem inflammatory syndrome and fatal acute limb ischaemia
date: 2021-12-01
journal: Respirol Case Rep
DOI: 10.1002/rcr2.886
sha: b98ccac7852fe76d5f6e877257bb62cee75e45a8
doc_id: 1035936
cord_uid: s35vzeag

A case of coronavirus disease 2019 (COVID‐19)‐induced adult multisystem inflammatory syndrome (MIS) and fatal acute limb ischaemia is presented. Arterial thrombosis and MIS are reported as complications of COVID‐19. This case further highlights that arterial thrombosis and MIS can occur in COVID‐19.

A 72-year-old man presented to our hospital with a 1-week history of dyspnoea and pain in the left lower leg. The patient had a history of untreated type 2 diabetes mellitus (HbA1c 14.1%; reference range, 4.6%-6.2%) and no history of smoking. No heart disease or peripheral vascular disease was found previously. Laboratory examinations showed elevated levels of D-dimer (258.8 μg/ml; reference range, 0.0-1.0 μg/ml) and C-reactive protein (31.57 mg/dl; reference range, 0.0-0.14 mg/dL), and decreased platelet count (83,000/μl). A nasopharyngeal swab was positive for coronavirus disease 2019 (COVID-19) on real-time polymerase chain reaction testing. Computed tomography showed lower extremity arterial thrombosis, COVID-19 pneumonia, myocarditis, aortitis and pulmonary thromboembolism ( Figure 1A -E). The electrocardiogram showed ST elevation and inverted T waves in the precordial leads ( Figure 1F ). Cyanosis and multiple blisters occurred after hospitalization ( Figure 2 ). During the placement of a central venous femoral vein catheter, the femoral artery was accidentally punctured; thus, anticoagulants were not administered due to bleeding risk. Open surgical or endovascular thromboembolectomy was not performed due to the patient's poor general condition. COVID-19-induced adult multisystem inflammatory syndrome (MIS) 1 and acute limb ischaemia were diagnosed. The patient died on the 17th day of hospitalization due to uncontrolled circulatory failure. According to the criteria of the International Society on Thrombosis and Haemostasis, 2 the patient's total score for disseminated intravascular coagulation was 6 points, indicating the presence of overt disseminated intravascular coagulation. COVID-19 patients may present with symptoms of thrombosis or MIS, and appropriate testing is necessary.

The authors thank Forte Science Communications for the English language editing of our manuscript.

None declared.

Hiroshi Kobe: writing original draft. Akihiro Ito: supervision, writing, review and editing. Tadashi Ishida: visualization, writing, review and editing.

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

The authors declare that appropriate written informed consent was obtained for the publication of this case report and accompanying images. 

Multisystem Inflammatory Syndrome in Adults (MIS-A) Case Definition Information for Healthcare Providers. Page last reviewed

Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation

COVID-19-induced adult multisystem inflammatory syndrome and fatal acute limb ischaemia