A CASE OF COVID-19 ASSOCIATED MULTISYSTEM INFLAMMATORY SYNDROME RESULTING IN NEW ONSET HEART FAILURE IN AN ADULT M Bulathsinghala, MD PhD, 2 R Samson, MD Department of Internal Medicine, LSU Health Sciences Center; New Orleans, LA Department of Internal Medicine, Section of Cardiology, Tulane University Health Sciences Center, New Orleans LA INTRODUCTION COVID-19-related Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare complication seen 2 to 6 weeks after the resolution of an acute COVID-19 infection. There is only one previously described case of COVID-19 related hyperinflammatory syndrome in adults. Here we present a case of COVID-19 associated MIS causing myocarditis and new onset heart failure with reduced ejection fraction in an adult. CASE: A 23-year-old man presented with fever, fatigue, exercise intolerance, myalgias, headaches, and a positive COVID-19 PCR test approximately 5 weeks earlier. On admission, the patient was noted to be febrile to 102.2, tachycardic, and hypotensive. Physical exam was notable for bilateral conjunctival irritation and trace lower extremity edema. Labs on admit were significant for creatine of 1.67, mild transaminitis, BNP 262, Troponin 0.67, and WBC 12.8. Bedside echo performed in the Emergency Department was significant for a decreased LVEF 40-45%, global hypokinesis, and collapsible IVC. The patient was empirically treated with vancomycin and zosyn for possible sepsis however blood cultures remained clear and no source of infection was ever identified. Inflammatory markers were elevated with a LDH 252, D-Dimer 588, Ferritin 1,500, CPK 108, and CRP of 28. Angiogram of his chest showed no evidence of acute cardiopulmonary/airspace disease and no pulmonary embolism. Troponins peaked at 1.64 and CRP peaked at 37. DISCUSSION: The patient continued to worsen with no obvious source of infection with a pattern of inflammatory markers consistent with MIS in the setting of recent COVID-19 infection. The severity of his presentation prompted treating the patient according to MIS-C guidelines developed for children which included IVIG, IV steroids, and high dose aspirin which resulted in a quick resolution of his fever and improvement in his cardiac function and end-organ labs and markers. The patient was discharged home on aspirin and pantoprazole. Follow up echocardiogram one month later demonstrated a return of normal cardiac function.
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