The lips, scrotum, hands, and feet were swollen. There was bilateral scleral injection without any crust or exudate. The rash was most prominent on the chest, abdomen, central and lower back, flank, periaxillary regions, bilateral extensor elbow and knees, scrotum, inguinal folds, hands, and feet in a glove-and-stocking distribution. His exam was notable for a diffuse rash consisting of well-demarcated confluent erythematous patches interspersed with erythematous macules and targetoid lesions (Fig. Peripherally measured oxygen saturation was greater than 95% while receiving 2 L/minute supplemental oxygen via nasal cannula. Vitals were notable for sinus tachycardia to 170 beats per minute that only mildly improved with a 1 L fluid bolus. ![]() He was not prescribed any medications and denied smoking, alcohol use, or illicit drugs. The patient had no significant past medical or surgical history. He represented to the ED the following day for further evaluation. Additional symptoms included eye irritation, swelling of the lips, scrotum, hands, and feet, and progressive feedback. The rash was uncomfortable, making it difficult for him to sleep or be touched. After discharge, he noticed “a few red dots” on his arms and legs which progressed over the subsequent 12 hours to cover his hands, feet, arms, and legs. He was discharged from the emergency department (ED) after several hours of observation. Polymerase chain reaction-based testing for SARS-CoV-2 was positive. He reported first feeling unwell a few days prior to admission, with the gradual onset of fever, palpitations, diarrhea, and abdominal pain. Here, we describe a 29-year-old patient with COVID-19 who presented with minimal respiratory symptoms, prominent rash, and marked systemic inflammation. Numerous dermatological findings have been described in association with COVID-19 ranging from chilblains, petechiae, purpura, maculopapular rash, and urticaria. Less common is multisystem inflammatory syndrome in adults (MIS-A) -a syndrome that can include cardiovascular, gastrointestinal, and dermatologic manifestations. The mean age of children diagnosed with MIS-C is 8–9 years. This has been called multisystem inflammatory syndrome in children (MIS-C). ![]() Clinical hallmarks include fever, rash, conjunctivitis, distal extremity edema, mucous membrane changes, shock, and high inflammatory markers. ![]() Children display a more systemic inflammatory syndrome with high fever and Kawasaki’s disease-like findings. Adult patients with coronavirus disease 2019 (COVD-19) present primarily with respiratory symptoms such as cough and shortness of breath.
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