COVID-19-Associated Multisystem Inflammatory Syndrome Complicated with Giant Coronary Artery Aneurysm

Table 1

The main clinical course, medications, results of laboratory tests, and changes in the patient’s cardiac involvement during the hospital stay.

Variable	Hospital days
	1^st	3^rd	6^th	10^th	14^th	20^th
General appearance	Ill	Toxic	Toxic	Mildly ill	Fair	Good
Fever	Yes	Yes	Yes	No	No	No
Rash	Yes	Yes	Yes	Yes	No	No
Tachypnea	No	Yes	Yes	Yes	No	No
Hypotension	No	No	Yes	No	No	No
Total white blood cell count, ×10^6/L	22,000	21,800	27,000	28,300	25,700	21,880
Neutrophil, %	83	79	79	72	38	57
Lymphocyte, %	5	15	10	11	44	30
Monocyte, %	3	1	10	14	17	7
Hemoglobin, g/L	10.6	8.7	10	11.9	11.7	11.4
Platelet count, ×10^6/L	197,000	224,000	420,000	863,000	1,168,000	964,000
ESR	65	—	75	72	25	3
CRP, mg/L	38	—	38	25	10	29
AST, mg/dl	200	55	42	—	38	—
ALT, mg/dl	197	57	35	—	32	—
Antibiotic(s)	Cefotaxime	Meropenem, vancomycin	Meropenem, vancomycin	Meropenem	Meropenem	—
Daily main changes in medications	(i) IVIG (1^st) 2 gr/kg; (ii) ASA 15 mg/kg/q6h; (iii) Albumin 1 g/kg/day for 3 days; (iv) Hydroxychloroquine 5 mg/kg/day for 5 days	(i) IVIG (2^nd) 2 gr/kg; (ii) Packed RBC transfusion 10 ml/kg; (iii) Captopril 0.3 mg/kg/q8h for 3 days; (iv) Fresh frozen plasma 10 ml/kg	(i) Prednisolone 2 mg/kg/day; (ii) Dopamine 6 micg/kg/min; (iii) Milrinone 0.5 micg/kg/min; (iv) Packed RBC transfusion 10 ml/kg; (v) Albumin 1 g/kg/day for 3 days	(i) Clopidogrel 0.5 mg/kg/day continued until discharge; (ii) Captopril 0.3 mg/kg/q8h	(i) Prednisolone tapered; (ii) Heparin 10–20 U/kg/h for 3 days; (iii) ASA 5 mg/kg/day continued until discharge	(i) Warfarin 0.1 mg/kg/day started from the 16^th day and continued until discharge; (ii) Infliximab 5 mg/kg on the 19^th day
Echocardiography	Minimal MR, normal coronary arteries, good LVEF	Mild to moderate MR, TR and PI, mild coronary dilatation in LAD and LCX, diastolic dysfunction, good LVEF	Moderate MR and TR, ectatic coronary arteries, mild diastolic dysfunction, LVEF: 43%	Minimal MR, mild TR and PI, moderate aneurysmal coronary artery: RCA: 5.8 mm, LMCA: 6.2, LAD: 5.9, LVEF: 62%	Minimal MR, mild TR, minimal PI, dilated aneurysmal RCA: 7.8 mm, LMCA: 7.7 mm, LAD: 5.7 mm, good LVEF	Minimal MR, no TR, minimal PI, giant aneurysms in RCA: 8.3 mm, LMCA: 7.7 mm, LAD: 7.3 mm, good LVEF

ESR = erythrocyte sedimentation rate; CRP = C-reactive protein; ALT = alanine aminotransferase; AST = aspartate aminotransferase; MR = mitral regurgitation; TR = tricuspid regurgitation;PI = pulmonary insufficiency; PE = pericardial effusion; RCA = right coronary artery; LAD = left anterior descending coronary artery; LMCA = left main coronary artery; LVEF = left ventricular ejection fraction.