A Case of Adult Multisystem Inflammatory Syndrome Following COVID-19 Vaccine

Abstract

Multisystem inflammatory syndrome is a life-threatening condition associated with elevated inflammatory markers and multiple organ injury. A diagnosis of exclusion, it has been reported after severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) in children and adults; recently it has been described in some post-COVID-19 vaccinated individuals. The prognosis with supportive care and immunomodulatory therapy is good, although some individuals may require treatment in the intensive care unit (ICU). Here we report a case of a 58-year-old man who developed multi-organ failure after receiving the second dose of the Moderna mRNA-1273 COVID-19 vaccine. He required critical organ support in the ICU. An extensive workup was done to rule out alternative infectious and inflammatory processes. Following a period of gradual in-hospital convalescence, our patient made a full recovery. To our knowledge, this is the first comprehensively described case of multisystem inflammatory syndrome associated with Moderna mRNA-1273 COVID-19 vaccine in an adult over 50 years of age.

Acute Liver Failure Caused by Secondary Hemophagocytic Lymphohistiocytosis After COVID-19 Vaccination – Case Report and Literature Review

“…The pathophysiology of MIS-V probably reflects those of MIS-C/A. 7,15 The aberrant immune response to vaccination, in addition to being linked to the development of MIS-V, is also associated with the development of antibodies resembling those recognising PF4-heparin complex. The described antibodies can cause atypical thrombosis and pronounced thrombocytopenia 1-2 weeks after vaccination with ChAdOx1 nCov-19, an entity called vaccine-induced thrombotic thrombocytopenia (VITT).…”

Understanding COVID-19 in children: immune determinants and post-infection conditions

“… 112 – 114 As for MIS-C, MIS-V is also an almost exclusively pediatric form, as cases reported in the literature among adults are anecdotal. 144 Early reports have proposed that individuals with MIS-V manifest immune system hyperresponsiveness due to recent asymptomatic or symptomatic SARS-CoV-2 infection often suggested by a familial cluster or ascertained by nasopharyngeal swab. 145 , 146 Hence, the vaccination could be a trigger of inflammation in individuals who were recently infected.…”