Shock por enfermedad de Kawasaki post COVID-19: a propósito de un caso
Post-COVID-19 Kawasaki disease shock: a case report

William Moreno, José Bracho, Manuel Méndez, Marco Gil

Resumen



La enfermedad por coronavirus 2019 (COVID-19) afecta a gran parte de la población mundial. Aunque la mayoría de los niños con COVID-19 presentan una enfermedad asintomática, se han reportado casos con manifestaciones compatibles con estados hiperinflamatorios y/o enfermedad similar a la de Kawasaki. La enfermedad de Kawasaki (EK) es definida como una vasculitis sistémica idiopática que afecta predominantemente a niños menores de 5 años y con menor frecuencia a niños de edades mayores, permaneciendo desconocida su patogenia. El síndrome inflamatorio multisistémico pediátrico (SIM-P) se presenta como una respuesta inmunitaria adaptativa con manifestaciones clínicas cardiovasculares relevantes. Se presenta el caso de un adolescente femenino con alzas térmicas persistentes, epistaxis y hemorragia conjuntival bilateral, quien ingresa a la unidad de cuidados intensivos pediátricos (UCIP) por inestabilidad hemodinámica, con los diagnósticos de SIM-P post COVID-19 y shock por EK, tratado con corticosteroides, inmunoglobulina intravenosa, ácido acetilsalicílico y antibioticoterapia, mejorando progresivamente, con posterior alta médica y control por consulta externa.

Coronavirus disease 2019 (COVID-19) affects much of the world’s population. Although most children with COVID-19 have an asymptomatic disease, manifestations consistent with hyperinflammatory states and/or Kawasaki-like disease have been reported. Kawasaki disease (KD) is defined as an idiopathic systemic vasculitis that predominantly affects children under 5 years of age and less frequently in olders, and its pathogenesis remains unknown. Multisystem inflammatory syndrome in children (MIS-C) presents as an adaptive immune response with relevant cardiovascular manifestations. We present the case of a young female with persistent fever, epistaxis and bilateral conjunctival hemorrhage, who was admitted to the pediatric intensive care unit (PICU) due to hemodynamic instability, with the diagnoses of MIS-C post COVID-19 and shock by KD, who was treated with corticosteroids, intravenous immunoglobulin, acetylsalicylic acid and antibiotic therapy, showing progressive improvement, with subsequent medical discharge and control by external consultation. 


Palabras clave


COVID-19; Kawasaki; shock; síndrome inflamatorio multisistémico. shock; multisystem inflammatory syndrome.

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Referencias


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