Harlequin Syndrome in A Young Adult with Multi-System Inflammatory Syndrome Post COVID-19

COVID-19 patients have a heterogeneous disease course; it may be asymptomatic or cause only mild symptoms, while immunologic complications resulting in cytokine storm syndrome may also occur. Hereby, we present a young patient with cardiogenic shock and multi organ failure, suggesting Pediatric Multi-System Inflammatory Syndrome (MIS-C), which developed myocardial dysfunction that led to cardio-respiratory arrest, therefore required ECMO support. Whilst on ECMO, the patient stabilized very quickly however suffered from an acute event of severe hypoxemia and brain injury, possibly secondary to Harlequin syndrome. He was therefore converted to VA-V ECMO, and then to VV ECMO once the heart recovered completely, and managed to wean off ECMO support.