An adult presentation consistent with PIMS-TS: The Lancet
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Following reports of paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS), a UK-born man of Somali origin, aged 21 years, was admitted to University College London Hospitals (UK) with 6 days of fever and abdominal pain associated with constipation, anorexia, and headache.

He described a transient maculopapular palmar rash 4 days into illness. He had non-exudative conjunctivitis, cervical lymphadenopathy, cracked lips, and prominent lingual papillae. A CT scan showed mesenteric adenopathy and terminal ileitis. The patient had neutrophilia, eosinophilia, lymphopenia, elevated inflammatory markers, and elevated troponin T with normal electrocardiogram, transthoracic echocardiogram, and CT coronary angiogram.

The patient had no previous history of COVID-19 symptoms or contact with known COVID-19 cases. Nasopharyngeal and stool samples were negative for SARS-CoV-2 by PCR. Other infective and inflammatory conditions were excluded. Adult and paediatric specialists conferred and concluded that the most likely diagnosis was Kawasaki-like disease on the PIMS-TS spectrum.

The patient was treated with intravenous immunoglobulin and methylprednisolone, which resulted in rapid resolution of symptoms and normalisation of blood parameters; he was discharged on low-dose aspirin 8 days after admission to hospital.

Kawasaki disease has been described in adults in association with viral infection. To the best of knowledge, this is the first reported case of adult Kawasaki-like disease related to SARS-CoV-2 infection.

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