Background. Multisystem inflammatory disorder in children and adolescents is a relatively new and rare complication of COVID-19. This complication seems to develop after the infection rather than during the acute phase of COVID-19. The clinical features are similar to a well-known inflammatory syndrome in children, Kawasaki disease, and it can lead to collapse and multiple organ failure requiring intensive care. The COVID-19-associated multisystem inflammatory syndrome in children and adolescents is referred to mutually as pediatric inflammatory multisystem syndrome temporally linked with SARS-CoV-2 (PIMS-TS) or multisystem inflammatory syndrome in children (MIS-C) correlated with COVID-19, and here, it is referred to as MIS-C. Case Presentation. This report describes a nine-month-old Asian infant presented with a two-week history of fever with nonspecific signs of viral illness and erythematous rash. The clinical and biochemical findings were compatible with complicated typical Kawasaki disease (KD). The infant fulfilled the World Health Organization criteria for MIS-C and was treated with intravenous immunoglobulin and anticoagulation, which he responded well to. He was discharged home in good condition after almost 3 weeks of treatment. Conclusion. This case highlights a rare but new phenomenon attributed to severe acute respiratory syndrome coronavirus 2 infection. We report the first case report of MIS-C in the United Arab Emirates and Arab region. Among KD&#x2019;s complications, massive aneurysm with thrombosis is rare and usually will have deleterious results if not diagnosed and managed promptly.

Ghassan Ghatasheh

Huda Al Dhanhani

Ashutosh Goyal

Muhammad Bassel Noureddin

Doaa Al Awaad

Ziad Peerwani

COVID-19-Related Giant Coronary Aneurysms in an Infant with Multisystem Inflammatory Disorder in Children: The First Case Report from the United Arab Emirates and the Arab Region

Background. Coronavirus disease (COVID-19) is a worldwide pandemic causing multiple fatalities and morbidities worldwide. We report a case of severe pneumonia causing acute respiratory distress syndrome due to a coinfection with SARS-CoV-2 and Mycobacterium abscessus in an elderly patient with multiple myeloma in Florida, USA. Case Presentation. An 84-year-old male with a medical history significant for multiple myeloma not in remission was sent to the emergency department to rule out COVID-19 infection prior to continuing his chemotherapy sessions. At presentation, he had nonspecific mild symptoms and an unremarkable physical examination. He had significant blood test findings including serum lactate dehydrogenase 373&#x2009;U/L, high sensitive C-reactive protein 17.40&#x2009;mg/l, and ferritin 415&#x2009;ng/ml. Xpert-SARS-CoV-2 was positive. Chest radiograph revealed patchy areas of interstitial infiltrates in mid to lower lung zones. During his hospitalization course, his oxygenation deteriorated, requiring mechanical intubation. Repeat chest radiograph showed worsening bilateral infiltrates. He was started on broad-spectrum antibiotics and eventually weaned off mechanical intubation and extubated. On the 11th day of admission, he was found to be bradycardic and in shock, and he was reintubated. His labs showed worsening inflammatory markers along with kidney dysfunction to the point of requiring renal replacement therapy. He received both convalescent plasma and remdesivir for treatment of COVID-19 pneumonia. Eventually, repeat blood cultures came back positive for the growth of acid-fast beaded bacilli. While awaiting final culture and sensitivity reports, his antibiotics were upgraded to cover possible nocardia infection. Repeat blood and sputum cultures resulted in growth of AFB bacilli Mycobacterium abscessus 1&#x2009;week after. Conclusions. This case report highlights the importance of keeping a broad differential and considering multiple coinfections, including atypical ones during this COVID-19 pandemic, such as the one that was discussed above, Mycobacterium abscessus, in order to provide goal-directed therapy.

Jose A. Rodriguez

Charles Bonnano

Pratik Khatiwada

Alejandra A. Roa

Daniel Mayer

Paula A. Eckardt

COVID-19 Coinfection with Mycobacterium abscessus in a Patient with Multiple Myeloma

Dengue is an arboviral infection that affects humanscausing significant morbidity and mortality in tropical countries. Our first patient who had diabetes presented with shock and was managed as dengue hemorrhagic fever with superadded sepsis which required noradrenalin plus broad-spectrum intravenous antibiotics. The second patient developed severe bradycardia during the ascending limb of the critical phase with hemodynamic stability, which recovered on discharge. Third patient presented with severe and rapid leaking; we used intravenous albumin as an alternative colloid with good outcome. The fourth patient was a pregnant mother at term, and she went into spontaneous labor during the latter half of the critical phase. The fifth patient developed dengue hemorrhagic fever complicated with probable haemophagocytic lymphohistiocytosis. She was treated with intravenous steroids andimmunoglobulin, yet succumbed on day 7. Conclusion. Dengue is an extremely challenging and dynamic disease, which can lead to many unusual complications.A high index of suspicion is key to diagnose and treat promptly.

D. K. Jayaweera

S. Subasinghe

R. F. De Silva

W. A. H. P. Sanjeewa

K. P. Jayawickreme

Complicated Dengue Fever and Its Treatment Dilemmas: A Single-Center Experience in Sri Lanka

Brucellosis is a febrile zoonotic disease caused by one of several species of the Gram-negative coccobacillus Brucella. It is endemic to the Middle East, sub-Saharan Africa, and Central America. However, cases have also been reported in the United States. Infection is most commonly transmitted via unpasteurized dairy products or through occupational exposure to livestock. The clinical presentation is highly variable; symptoms may include fever, myalgias, night sweats, weight loss, nausea, and vomiting. Less common features include orchitis, osteomyelitis, and sacroiliitis. In addition, pregnant women who contract brucellosis face a markedly increased risk of miscarriage. A presumptive diagnosis is typically established through correlation of patient history and classic laboratory findings, which include transaminitis, anemia, and leukopenia with relative lymphocytosis. Definitive diagnosis can only be established through isolation of Brucella species from blood or tissues. Treatment involves a prolonged course of multiple antibiotics; six weeks of combination therapy with aminoglycoside or rifampin and tetracycline represents the most common regimen. Healthy individuals who develop brucellosis have a generally favorable prognosis, as the case fatality rate is less than 2&#x0025;. Nevertheless, early detection and treatment are essential to reduce the risk of long-term sequelae that may result from chronic, indolent disease.

Carina Chang

Bryce D. Beutler

Mark B. Ulanja

Chukwudum Uche

Milan Zdrnja

Brucellosis Presenting with Febrile Pancytopenia: An Atypical Presentation of a Common Disease and Review of Brucellosis

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Case Reports in Infectious Diseases publishes case reports and case series related to infectious diseases of bacterial, viral and parasitic origin.

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Case Reports in Infectious Diseases - Table of contents 2021

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Case Reports in Infectious Diseases publishes case reports and case series related to infectious diseases of bacterial, viral and parasitic origin.

Case Reports in Infectious Diseases