Aspirin/low-molecular-weight-heparins/methylprednisolone

Author Information

An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

A 28-year-old woman exhibited lack of efficacy during the treatment with aspirin, methylprednisolone and unspecified low molecular weight heparin for Kawasaki disease shock syndrome [routes not stated; not all dosages stated].

The woman was admitted to the emergency department with sudden onset skin rash that had started in the post-auricular area two days earlier and spread rapidly to other areas of the body. She reported sore throat, persistent fever, dry cough, fatigue and abdominal pain that had started seven days prior to admission. Thereafter, she was transferred to the ICU under oxygen support. She received treatment with unspecified crystalloids, norepinephrine and empirical antibiotic therapy with ceftriaxone and vancomycin. Point of care echocardiography showed severe systolic and diastolic dysfunction with biventricular distention and small pericardial effusion. Based on this findings, she received dobutamine. She was intubated. Laboratory test revealed signs of disseminated intravascular coagulation and sepsis. After stabilisation, a chest CT scan showed small alveolar condensation in the left lung. However, she was found to be COVID-19 positive. Based on these findings, she was diagnosed as Kawasaki disease shock syndrome secondary to COVID-19. Then, she received treatment with methylprednisolone 2 mg/kg/day, single dose of aspirin [acetylsalicylic acid] 500mg, unspecified low molecular weight heparin and plasmapheresis. Despite these measures, her haemodynamic status deteriorated rapidly. A lack of efficacy of aspirin, methylprednisolone and unspecified low molecular weight heparin was this considered. After 48 hours of admission, she died because of cardiac arrest refractory to cardiopulmonary resuscitation.