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Adult patients of severe COVID-19 can cause periungual desquamation like MIS-C.
Periungual desquamation may occur in the recovery phase, like pediatric patients.
Coronary artery lesions have been reported recovering from MIS-C.
Cardiac examination during the recovery phase may be necessary for adult patients.
We report a case of 50-year-old Japanese male who developed periungual desquamation in hand and feet, during recovery phase of severe COVID-19. As coronary lesions (CALs) have been reported during the recovery phase of severe COVID-19 in children as well as Kawasaki disease, caution may be necessary in adults as well.
A 50-year-old Japanese man was admitted to our hospital with a 14-day history of fever and sudden dyspnea. The patient was diagnosed with severe coronavirus disease (COVID-19) based on positive test results of RNA polymerase chain reaction for severe acute respiratory syndrome coronavirus. He was started on mechanical ventilation and extracorporeal membrane oxygenation (ECMO). He received ECMO for 23 days and was tracheostomized on hospital day (HD) 37. His general condition improved by HD 54. On HD 61, periungual desquamation appeared on the fingers of left hand (Panel 1A), left palm (Panel 1B), and both feet (Panel 1C). He satisfied the diagnostic criteria for Multisystem Inflammatory Syndrome in Children (MIS-C) other than age (
). There were no other conditions, which have potentially present the periungual desquamation, such as Kawasaki disease (KD) and Toxic Shock Syndrome during hospitalization. His result of bedside echocardiography, electrocardiogram and chest X-ray have revealed no abnormalities until 4 months on admission.
Severe COVID-19 in children have been reported to present with KD-like symptoms, MIS-C, and some of these have periungual desquamation during the recovery period (