Table 2 Timeline of patient’s disease process
About 4 weeks prior to presentation | Patient developed cold-like symptoms. His mother had similar symptoms, though worse in severity, and she test positive for COVID-19 |
About 2 weeks prior to presentation | Patient was vaccinated against COVID-19 with Pfizer/BioNTech vaccine |
One week prior to presentation | Patient developed fever, headache, sore throat, nausea, vomiting, and diarrhea |
About 4 days prior to presentation | Patient’s GI symptoms resolved. Patient tested negative on rapid strep and Monospot tests. Patient was prescribed amoxicillin and ondansetron |
Three days prior to presentation | Patient’s PO intake decreased. He was evaluated at an outside hospital Emergency Department, and no changes were made to his management |
Two days prior to presentation | Patient developed bilateral joint edema, erythema, heat, and pain in his metacarpophalanges, elbows, knees, and ankles. Additionally, he develops a rash |
One day before presentation | Patient’s pediatrician evaluated patient and found elevated CRP and ESR. Patient’s pediatrician discontinued patient’s amoxicillin and recommended that patient be seen at a children’s hospital with rheumatology and infectious disease capacity |
Day of presentation | Patient’s primary complaint was sore throat. His joint edema, pain, and erythema had improved, despite persistent erythema over his metacarpophalanges joints and edema bilaterally in his ankles. Patient was admitted to the hospital |
One day after presentation | Patient was evaluated by rheumatology and started on IVIG, methylprednisolone, and aspirin |
Three days after presentation | Patient had a negative echocardiogram. He was discharged from the hospital on a steroid taper |
About 2 weeks after discharge | At follow up with rheumatology, patient had a normal joint exam and some skin peeling. He had been taking NSAIDs for relief of sore throat and joint pain that worsened with the steroid taper. At follow up with cardiology, patient had a negative echocardiogram. He continued on aspirin |
About 2 months after discharge | Patient had a negative echocardiogram |