Case 2: Abdominal pain
A 15-year-old female (without underlying diseases) was admitted with
mild dyspnea, abdominal pain, nausea, and fever (from two days before
administration). At the time of admission, vital signs included
temperature = 39.8, systolic blood pressure = 90/50 mmHg, heart rate =
120/min, and O2 saturation = 95% without an oxygen
supply. In physical examination, filiform pulse and cold limbs were
observed. ECG revealed sinus tachycardia and inverted T wave in lateral
limb and precordial leads. Abdominal ultrasound showed an enlarged liver
span (146 mm) in favor of acute hepatitis. TTE revealed severe
ventricular (RV and LV) enlargement and dysfunction (LVEF = 5-10%), a
moderate degree of mitral regurgitation, PAP = 35 mmHg, and mild
pericardial effusion. Chest CT scan revealed bilateral GGO and
peripheral consolidations (Figure 1B). The patient was treated with
broad-spectrum antibiotics, corticosteroids (1 mg/kg
methylprednisolone/day), and remdesivir. The patient was discharged ten
days later in stable condition, with normalized WBC count and liver
enzymes. TTE revealed no change compared to the initial evaluation.
However, following up the patient for three months revealed LVEF of 20%
and dysfunctional and enlarged RV. Also, the patient suffered from
dyspnea during ordinary activities (function class II).