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31-year old beats Covid but dies weeks later with symptoms seen in CHILDREN
A 31-year-old woman checked in to a New Orleans hospital this spring after five days of fever, cough and stomach pain. Hospital workers stuck a long swab into her nose: She was positive for COVID-19 and given azithromycin and two days of hydroxychloroquine, the standard of care at the time.
By the time she was discharged, her temperature was normal and her oxygen levels were at 95%. But less than two weeks later, she was back at the hospital with a 103-degree fever, swollen neck and inflamed lymph nodes.
Even though a second nasal swab showed she was no longer positive for COVID-19, the woman's heart stopped and medical staff could not revive her.
When doctors performed an autopsy, they made a startling finding: the woman had characteristics pointing to a rare but life-threatening condition increasingly seen in children.
Multisystem inflammatory syndrome, or MIS, is thought to be a delayed overreaction of the immune system that can cause deadly heart inflammation and affect many organs. But doctors are starting to see the syndrome, which mimics Kawasaki’s disease, in adults, too.
“We thought it was important to report that it can happen to an adult,” said Dr. Sharon Fox, a pathologist at LSU Health New Orleans School of Medicine who authored the case report, published July 29 in the Annals of Internal Medicine. “It is possible to have serious consequences of coronavirus even after the initial infection.”
In children, scientists believe that the immune system kicks into overdrive after the initial infection of COVID-19 when antibodies fall to a low level, said Dr. Donna Farber, an immunologist at Columbia University who has studied the disease in children.
It suggests that they’re not clearing the virus well,” said Farber, who was not involved in the LSU study. “The virus kind of lingers ... and you get this smoldering immune response. Normally the lingering virus would be mopped up by antibodies.”
The residual virus tricks the body into turning on all defenses, culminating into what LSU researchers found in the 31-year-old’s heart: inflammation in the tiny blood vessels and other parts of the body that can lead to death without swift intervention.
MIS has been successfully treated with steroids and immunoglobulins in children. But because doctors aren’t used to being confronted with it in adults, it is less likely to be recognized.
LSU researchers hope this case, what they said is the first to look at the pathology of inflammation in the small vessels of the heart, will lead to more screenings that might be able to identify the progression of this overactive immune response earlier.
"Maybe we can find the biomarkers, the right test to order, linking up the pathology ... to identify those people.
Currently, there are no general recommendations for cardiovascular or biomarker screenings or follow-ups that might act as an early warning to flag the downstream consequences of a coronavirus infection.
The LSU researchers also found blood clots in the lungs of the woman, suggesting lung and vascular issues may show up after the patient is feeling better and considered recovered. People should keep tabs on their health even after leaving the hospital, they said.
“If they’re feeling sick or unwell, go back and be seen,” said Fox.
A small but growing number of case reports around the world are documenting MIS in adults. A 45-year-old man treated at New York University had similar symptoms, according to a case study published earlier this month in The Lancet. Doctors at a Brooklyn hospital treated a 36-year-old woman with Kawasaki-like disease. Both were later found to have coronavirus antibodies.
A 31-year-old woman checked in to a New Orleans hospital this spring after five days of fever, cough and stomach pain. Hospital workers stuck a long swab into her nose: She was positive for COVID-19 and given azithromycin and two days of hydroxychloroquine, the standard of care at the time.
By the time she was discharged, her temperature was normal and her oxygen levels were at 95%. But less than two weeks later, she was back at the hospital with a 103-degree fever, swollen neck and inflamed lymph nodes.
Even though a second nasal swab showed she was no longer positive for COVID-19, the woman's heart stopped and medical staff could not revive her.
When doctors performed an autopsy, they made a startling finding: the woman had characteristics pointing to a rare but life-threatening condition increasingly seen in children.
Multisystem inflammatory syndrome, or MIS, is thought to be a delayed overreaction of the immune system that can cause deadly heart inflammation and affect many organs. But doctors are starting to see the syndrome, which mimics Kawasaki’s disease, in adults, too.
“We thought it was important to report that it can happen to an adult,” said Dr. Sharon Fox, a pathologist at LSU Health New Orleans School of Medicine who authored the case report, published July 29 in the Annals of Internal Medicine. “It is possible to have serious consequences of coronavirus even after the initial infection.”
In children, scientists believe that the immune system kicks into overdrive after the initial infection of COVID-19 when antibodies fall to a low level, said Dr. Donna Farber, an immunologist at Columbia University who has studied the disease in children.
It suggests that they’re not clearing the virus well,” said Farber, who was not involved in the LSU study. “The virus kind of lingers ... and you get this smoldering immune response. Normally the lingering virus would be mopped up by antibodies.”
The residual virus tricks the body into turning on all defenses, culminating into what LSU researchers found in the 31-year-old’s heart: inflammation in the tiny blood vessels and other parts of the body that can lead to death without swift intervention.
MIS has been successfully treated with steroids and immunoglobulins in children. But because doctors aren’t used to being confronted with it in adults, it is less likely to be recognized.
LSU researchers hope this case, what they said is the first to look at the pathology of inflammation in the small vessels of the heart, will lead to more screenings that might be able to identify the progression of this overactive immune response earlier.
"Maybe we can find the biomarkers, the right test to order, linking up the pathology ... to identify those people.
Currently, there are no general recommendations for cardiovascular or biomarker screenings or follow-ups that might act as an early warning to flag the downstream consequences of a coronavirus infection.
The LSU researchers also found blood clots in the lungs of the woman, suggesting lung and vascular issues may show up after the patient is feeling better and considered recovered. People should keep tabs on their health even after leaving the hospital, they said.
“If they’re feeling sick or unwell, go back and be seen,” said Fox.
A small but growing number of case reports around the world are documenting MIS in adults. A 45-year-old man treated at New York University had similar symptoms, according to a case study published earlier this month in The Lancet. Doctors at a Brooklyn hospital treated a 36-year-old woman with Kawasaki-like disease. Both were later found to have coronavirus antibodies.
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