2022, Number 2
Med Int Mex 2022; 38 (2)
Herrera-García JC, Arellano-Montellano EI, Nuche-Salazar NP, Acosta-Sánchez H, Téllez-Bautista M, Enciso-Figueroa G, Balandrano-TrujilloTJ, Delabra-Navarro F
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ABSTRACTBackground: Multisystemic inflammatory syndrome of the adult, a new condition associated with an irregular immune response similar to that of children, is characterized by shock, heart failure or persistent hypotension, dyspnea on exertion, mild-moderate hypoxemia, gastric symptoms and elevated markers of systemic inflammation after severe COVID-19 pneumonia.
Clinical case: A 56-year-old patient, uncontrolled diabetic, who presented symptoms associated with dyspnea, desaturation, chest pain and persistent fever, previously with severe pneumonia after one month of treatment. He was treated with oxygen, steroids and antibiotics for 3 weeks, but his symptoms worsened and he developed severe orthopnea, hypotension, chest pain, dyspnea at rest and severe desaturation, as well as elevation of inflammation markers (C-reactive protein, ESR, D-dimer, ferritin). Tomography of the chest showed residual pneumonia based on consolidation and ground glass. Echocardiogram evidenced diastolic dysfunction, myopericarditis and secondary endocarditis. Multisystemic inflammatory syndrome of the adult was diagnosed and patient was treated with IV immunoglobulin and steroid with a favorable response to treatment.
Conclusions: This case shows that the adult systemic inflammatory syndrome is a differential diagnosis in a patient with shock of unknown etiology, heart failure and severe dyspnea previously infected by SARS-CoV-2. Immunoglobulin and steroid are the effective first-line treatment with excellent clinical response.