Medical Case Reports

Introduction

The multifactorial etiology disorders of Systemic Capillary Leak Syndrome (SCLS) and Multisystem Inflammatory Syndrome In Adults (MIS-A) are extremely uncommon complications of COVID-19 infection. The inflammatory state brought on by COVID-19 infection is thought to be what causes both conditions. Repetitive Coronavirus related attending/progressive indications of the two problems have not been accounted for yet. We describe a 38-year-old Asian man with a COVID-19 infection who first presented with fever, cough, and shortness of breath, body aches, dizziness, and epigastria pain. A couple of days before this show, a similar patient created multisystem fiery condition in grown-ups (MIS-A). He was later diagnosed with new-onset Systemic Capillary Leak Syndrome (SCLS) based on clinical and laboratory tests. Notwithstanding resuscitative measures, the patient died. A growing cause for concern is the increased risk of inflammatory complications that come with COVID-19 infection.

Rare Multifactorial Disorder

Our case illustrates the significance of COVID-19 awareness in underserved and less educated regions with fewer information resources. With equal emphasis, rare and fatal manifestations should also be advertised and discussed with the general public. This case demonstrates how crucial it is to utilize clinical knowledge and decision-making in order to manage such rare and complex disorders and to comprehend the pathophysiology of new-onset systemic capillary leak syndrome in a patient who has had recurrent COVID-19 infections. Systemic Capillary Leak Syndrome (SCLS) is a rare multifactorial disorder that starts out as a prodrome of non-specific symptoms and eventually leads to a group of fatal symptoms like hypotension, edema, hemoconcentration, and shock. SCLS is fatal. Although identifiable triggers like viral infections, prolonged travel, and vigorous physical activity have been identified, the majority of SCLS cases are idiopathic. A case that Ebdrup et al. reported associated infection with the influenza virus with new-onset SCLS. Expanded vascular penetrability because of endothelial harm from incendiary substances is the basic pathophysiology of SCLS. The 2019 Coronavirus Disease (COVID-19) can cause a wide range of symptoms and a generalized inflammatory state in the body. SCLS has only rarely been seen in COVID-19 patients. We report the primary instance of new-beginning fundamental slender break disorder in a patient with repetitive Coronavirus contamination who had basic multi-framework provocative condition in grown-ups (MIS-A) because of earlier Coronavirus disease. Our case is extraordinary from other recently distributed cases in that the patient created SCLS just subsequent to creating MIS-A because of a second Coronavirus disease. This case report has been accounted for in accordance with the Alarm Models. For the first day, a 38-year-old man presented with fever, cough, shortness of breath, body pain, dizziness, and epigastric pain. This patient was treated for a COVID-19 infection and its complications twice at the same hospital. He presented with severe shortness of breath, cough, and fever on his first visit in November 2021. Based on his clinical and radiographic features on High Resolution Computed Tomography (HRCT) of the chest, he was diagnosed with a severe COVID-19 infection. A COVID-19 infection was also detected by Reverse Transcription-Polymerase Chain Reaction (RT-PCR).

Signs of Infection

He was first moved to the isolation floor and given oxygen through a straightforward oxygen mask. He was put on oxygen therapy using a Non-Breathable (NRB) mask because he was unable to maintain his oxygen saturation. His respiratory condition continued to deteriorate in spite of every intervention. He was moved to the hospital's COVID critical care unit, where he was given mechanical ventilation and other medical treatments. After a series of double-negative RT-PCR tests for COVID-19 infection, his respiratory condition gradually improved, and he was discharged after 22 days. The same patient presented to the emergency department in the first week of January 2022 with a fever, altered consciousness, abdominal pain, diarrhea, and a maculopapular rash on the chest and abdomen. There was no shortness of breath or cough. He had a fever of 39.5 degrees Celsius, a blood pressure of 110/70 mmHg, and an oxygen saturation of 96%. The patient's Glasgow Coma Scale (GCS) level was 12/15 (E3V4M5) during systemic examination. On the chest and abdomen, a blanching, non-pruritic maculopapular was observed. Isotonic fluids, empiric antibiotics like ceftriaxone and vancomycin, and paracetamol were used to treat the patient. For routine laboratory tests, a venous blood sample, a urine sample, and a COVID-19 nasopharyngeal swab were taken. Two times, the RTPCR test came back negative. Despite taking ongoing medication, the patient did not improve while in the hospital. Processed tomography of the chest, midsection, and pelvis was finished, not showing any critical discoveries. None of the blood cultures showed any signs of infection. The condition of the patient was getting worse. The maculopapular rash spread to both upper and lower appendages yet saved hands and feet. A diagnosis of Post-COVID Multisystem Inflammatory Syndrome in Adults (MIS-A) was made after clinical and radiological examinations. The patient was started on intravenous dexamethasone treatment, which was then different to oral structure once the patient's condition became steady. With treatment, the inflammatory markers decreased gradually, and the maculopapular rash went away. After five days, the antibiotics were stopped. On the 12th day of admission, the patient was stable, and all of the laboratory tests were within the normal range. After receiving adequate counseling, he was released on the thirteenth day. The patient returned to the emergency department three days after being discharged, complaining of fever, cough, shortness of breath, body aches, dizziness, and epigastric pain for one day. On show to the medical clinic, the circulatory strain was 80/40 mmHg, beat rate was 136 bpm, respiratory rate was 28/min, and oxygen immersion was 88% on room air. On assessment, the patient had coarse pops in two-sided lower lung fields. On both lower limbs, massive bilateral edema was also observed. A nasopharyngeal swab was taken for COVID-19 RT-PCR because of the high clinical suspicion; the result was positive, indicating that the patient had been infected with COVID-19 before. Along with broad-spectrum antibiotics, 5 L of crystalloid was given to the patient. Pericardial effusion was detected by echocardiography.