Multiple system inflammatory syndrome associated with SARS-CoV-2 infection in an adult and an adolescent

Abstract

Multisystem inflammatory syndrome in adults (MIS-A) is a new syndrome related with COVID-19. A case-based review was performed to present real-life experiences in terms of main findings and treatment options. We described two cases with the diagnosis of MIS and searched the literature to review all reported ≥ 18-year-old cases. The PubMed, Scopus, and Web of Science databases were searched. All relevant articles from January 2020 to February 2021 were reviewed. An adolescent and an adult patient (18 and 40 years-old, respectively) with the diagnosis of MIS were presented. Both had the consistent clinical findings with the case definition criteria. Although steroid, intravenous immunoglobulin (IVIG) and supportive care treatments have been suggested in the literature, there exists no treatment guideline for MIS-A. The clinical and laboratory findings of the patients progressively improved with the implementation of the IVIG and the pulse steroid treatments. A total of 51 cases (≥ 18 years-old) with MIS were analyzed. Mean age was 29.4 ± 10 years. Fever (80.4%), gastrointestinal (72.5%), and respiratory symptoms (54.9%) were the predominant symptoms. Cardiovascular abnormalities were the most frequent reported findings (82.4%, 42/51). The dermatological and conjunctival findings were reported in 39.2% and 35.3% of the patients, respectively. The increased level of inflammatory biomarkers was remarkable. Most of the patients were treated successfully with steroid and IVIG. Clinicians managing adult patients should keep in mind the development risk of MIS related with SARS-CoV-2 infection to perform necessary interventions properly without delay. IVIG and pulse steroid treatments are the effective options on clinical improvement.

The First Case of Multisystem Inflammatory Syndrome in Adult after COVID-19 in Korea

“…In the previous report, 3 20% and 6% of patients needed mechanical ventilation and extracorporeal membrane oxygenation, respectively, and mortalities have occurred in 4.1%. Our patient was admitted to the intensive care unit because of severe shock, receiving high dose of inotropes and vasopressors.…”

“…For example, tocilizumab which is an inhibitor of interleukin-6 was used in 13.7% of patients in the previous report. 3 …”

“…Clinical syndrome with similar features also have been described in adult patients. 2 3 The MIS in adults (MIS-A) is characterized by shock with predominant extrapulmonary symptoms such as gastrointestinal, cardiovascular, dermatologic, or neurologic symptoms that occur 2–6 weeks after COVID-19. Herein, we report the first case of MIS-A in South Korea.…”

Multisystem inflammatory syndrome in adults: A rare sequela of SARS-CoV-2 infection

“…The first reported case series of CDC Morbidity and Mortality Weekly Reports (MMWR) included 11 MIS-A patients based on data collected from March to August, 2020, seven of whom underwent cardiogenic shock on presentation (Morris et al, 2020). Similarly, a recent review of 51 cases with MIS-A highlighted that cardiovascular involvement has been the most frequently reported finding (82.4%), followed by gastrointestinal manifestations (72.5%) (Bastug et al, 2021). Importantly, in MIS-A, initial COVID-19 infection can be asymptomatic too (Morris et al, 2020).…”

“…Most of our understanding of MIS-A is based on various case reports and case series shared by the CDC and published in the medical literature (Bastug et al, 2021;Morris et al, 2020). Here we describe a case of MIS-A in a patient admitted to the Creighton University Medical Center -Bergan Mercy campus in Omaha, Nebraska with clinical presentation and diagnostics suggestive of MIS-A.…”