A Case of Complete Heart Block and Acute Appendicitis in a Young Patient With COVID-19

Recently, coronavirus disease 2019 (COVID-19, caused by SARS-CoV-2) has posed a challenge for clinicians, particularly extrapulmonary manifestations. These manifestations are often rare and difficult to recognize as research is still underway for the myriad presentations of the disease. A 19-year-old man presented with viral upper respiratory infection (URI) symptoms and received a positive result for SARS-CoV-2 real-time reverse transcription polymerase chain testing. A few days later, he developed abdominal pain and presented to the Emergency Department (ED). He was found to have bradycardia, right lower quadrant pain, fevers, and elevated inflammatory markers. An abdominal computed tomography scan showed appendicitis and an electrocardiogram showed third-degree heart block. He underwent successful implantation of a dual-chamber permanent pacemaker and was scheduled for elective appendectomy. This case illustrates a state of system-wide inflammation that has been described mainly in pediatric patients with SARS-CoV-2 known as multisystem inflammatory syndrome in children (MIS-C). Recognition of this syndrome is crucial as it has potential diagnostic and therapeutic implications that can improve outcomes.