成人におけるCOVID-19関連川崎様多系統炎症性疾患

COVID-19 associated Kawasaki-like multisystem inflammatory disease in an adult.

• Sabrina Sokolovsky
• Parita Soni
• Taryn Hoffman
• Philip Kahn
• Joshua Scheers-Masters

抄録

近年，COVID-19感染後の二次性多系統炎症性症候群（Multisystem Inflammatory Syndrome in Children：MIS-C）が報告されており，川崎病（KD）の特徴を有することが多い．本症例は36歳女性で，発熱，腹痛，嘔吐，下痢が1週間続いた後，血圧低下と頻脈を訴えて救急外来を受診し，非滲出性結膜炎，唇のひび割れ，手足の浮腫，口蓋紅，びまん性黄斑部発疹，頸部リンパ節腫脹を含む完全川崎病の典型的な表現型を呈した．初期の臨床検査では，低ナトリウム血症，直接高ビリルビン血症を含む肝機能検査の上昇，好中球症を伴う白血球症が認められた．画像診断では軽度の胆嚢壁浮腫、小範囲の大腸炎、小胸水が認められた。彼女は川崎病ショック症候群（KDSS）の治療を受けたが，症状はほぼ消失し，1日以内にバイタルサインは正常化し，その後の臨床検査値は改善した．後にCOVID-19 IgG陽性であることが判明し、過去の曝露を示唆している。この症例は、MIS-Cに類似したCOVID-19の過去の感染の血清学的証拠を持つ成人におけるKD様疾患の初期報告である。これは、SARS-CoV-2の病原性株が、成人だけでなく小児においてもKDに類似した感染後炎症性症候群を引き起こすことを示唆している。無数のCOVID-19の症状や後遺症の理解は急速に進んでいる。我々は、KD/KDSSに類似した炎症性症候群に注意を払い、IVIGとステロイドによる迅速な治療を行うことを推奨する。

Recent reports have described a secondary Multisystem Inflammatory Syndrome in Children (MIS-C) after a prior COVID-19 infection that often has features of Kawasaki disease (KD). Here, we report the case of a 36-year-old woman who presented to the emergency department hypotensive and tachycardic after 1 week of fevers, abdominal pain, vomiting and diarrhea, and was found to have the classic phenotype of complete Kawasaki's Disease including nonexudative conjunctivitis, cracked lips, edema of the hands and feet, palmar erythema, a diffuse maculopapular rash, and cervical lymphadenopathy. Initial laboratory studies were significant for hyponatremia, elevated liver function tests including direct hyperbilirubinemia, and leukocytosis with neutrophilia. Imaging revealed mild gallbladder wall edema, a small area of colitis, and small pleural effusion. She was treated for Kawasaki Disease Shock Syndrome (KDSS) with pulse dose solumedrol, IVIG, and aspirin with near resolution of symptoms and normalization of vital signs within 1 day and subsequent improvement in her laboratory abnormalities. She was later found to be COVID-19 IgG positive, suggesting past exposure. This case represents an early report of a KD-like illness in an adult with serologic evidence of a previous COVID-19 infection, similar to MIS-C. It suggests that the virulent strain of SARS-CoV-2 appears to cause a post-infectious inflammatory syndrome similar to KD in adults, as well as children. Our understanding of the myriad of COVID-19 symptoms and sequelae is rapidly evolving. We recommend physicians remain vigilant for inflammatory syndromes that mimic KD/KDSS which may warrant prompt treatment with IVIG and steroids.

Copyright © 2020. Published by Elsevier Inc.