Multisystem Inflammatory Syndrome in a Previously Vaccinated Adolescent Female With Sickle Cell Disease

Abstract

Multisystem inflammatory syndrome in children (MIS-C) is a serious complication that is observed most commonly in pediatric patients following severe acute respiratory syndrome coronavirus 2 infections. However, the mechanism and predictors of disease are poorly understood. There are no prior reports of MIS-C among patients who have been fully vaccinated, and only a single case of MIS in an adult patient who had received his second shot just 4 days prior to symptom onset. Here, we present an adolescent with sickle cell disease who was fully vaccinated against severe acute respiratory syndrome coronavirus 2 and had no prior history of known or suspected infection, who presented in shock and was ultimately diagnosed with MIS-C. This case highlights the importance of clinical suspicion for MIS-C even when patients are fully vaccinated.

Reported cases of multisystem inflammatory syndrome in children aged 12–20 years in the USA who received a COVID-19 vaccine, December, 2020, through August, 2021: a surveillance investigation

“…10 , 25 Globally, MIS-C in individuals who had received a COVID-19 vaccine has been described in detail in the literature for eight individuals younger than 21 years, 22 , 26 , 27 , 28 , 29 , 30 , 31 excluding aggregate counts from larger analyses assessing the effect of vaccination on preventing MIS-C. 32 , 33 From the USA, two reports included three cases that are also in our surveillance results, 22 , 26 and one report described a 14-year-old child with evidence of previous SARS-CoV-2 infection (positive anti-nucleocapsid antibody test) with MIS-C onset 2 months after a second dose with BNT162b2. 31 From outside the USA, we found reports of two individuals without evidence of previous or recent SARS-CoV-2 infection and who tested negative for anti-nucleocapsid antibodies: from Denmark, a 17-year-old with MIS-C onset 5 days after dose two of BNT162b2; 28 and from Turkey, a 12-year-old with onset 27 days after dose one of BNT162b2. 27 Two other reports described one person each for whom SARS-CoV-2 infection status was unclear; NAAT or antigen tests were negative but anti-nucleocapsid antibody testing was not done or not described.…”

Reported Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) Aged 12–20 Years in the United States Who Received COVID-19 Vaccine, December 2020 through August 2021

“…23 A third reported person from the United States had received dose two of the Pfizer-BioNTech vaccine two months prior to presentation and had evidence of infection with a positive antinucleocapsid antibody test during MIS-C illness evaluation (NAAT was negative). 30 Two other reported cases were European adolescents; one without evidence of SARS-CoV-2 infection (onset five days after Pfizer-BioNTech dose 2), the other SARS-CoV-2 NAAT negative and anti-nucleocapsid antibody testing not described (onset 10 weeks after Pfizer-BioNTech dose 2). 27,28 Lastly, a sixth report in the literature was of a 12-year-old child from Saudi Arabia who developed MIS-C five weeks after a dose of Moderna COVID-19 vaccine (he received a dose of Pfizer-BioNTech vaccine three weeks before the Moderna dose); this child had negative SARS-CoV-2 NAAT testing, anti-spike antibody testing was positive, and anti-nucleocapsid antibody testing was not performed.…”

“…14,26 Globally, MIS-C following COVID-19 vaccination has been reported in the literature for six persons <21 years of age. 23,[27][28][29][30] Two of these persons are from the United States and are included in our case series; both had evidence of SARS-CoV-2 infection. 23 A third reported person from the United States had received dose two of the Pfizer-BioNTech vaccine two months prior to presentation and had evidence of infection with a positive antinucleocapsid antibody test during MIS-C illness evaluation (NAAT was negative).…”

Case Report: MIS-C With Prominent Hepatic and Pancreatic Involvement in a Vaccinated Adolescent – A Critical Reasoning

“…A study by Zambrano et al analyzing the efficacy of Pfizer-BioNTech mRNA vaccination evidenced only five cases of MIS-C in adolescents who have received two doses of vaccine ( 6 ). Additionally, other few isolated case reports have been published, including that of a previously vaccinated adolescent patient with sickle cell disease ( 20 ). None of the cases reported in literature required intensive care support, thus suggesting a potential protection against life-threatening MIS-C in vaccinated people ( 6 , 20 ).…”

“…Additionally, other few isolated case reports have been published, including that of a previously vaccinated adolescent patient with sickle cell disease ( 20 ). None of the cases reported in literature required intensive care support, thus suggesting a potential protection against life-threatening MIS-C in vaccinated people ( 6 , 20 ). The low incidence of MIS-C in vaccinated people, together with the reduced spectrum of severity observed significantly support the utility of anti-SARS-CoV-2 vaccination in children and adolescents, although vaccine hesitancy among caregivers is still consistent ( 21 ).…”