Multisystem inflammatory syndrome in adults: a case report and review of the literature

Abstract

Background The current coronavirus disease pandemic has brought recognition of multisystem inflammatory syndrome in adults as a de novo entity, temporally associated with severe acute respiratory syndrome coronavirus 2 viral infection in adults. Hypothesis about its true pathophysiology remains controversial. Case report The patient was a 22-year-old African American female presenting to the emergency department with fever, sore throat, and neck swelling for the past 3 days. During her initial emergency department visit, her blood pressure was stable at 110/57 mmHg, temperature of 39.4 °C, and heart rate of 150 beats per minute. While in the emergency department, she received broad-spectrum antibiotics (vancomycin and ceftriaxone) and 30 cc/kg bolus of normal saline. Originally, she was admitted to a telemetry floor. The following night, a rapid response code was called due to hypotension. At that time, her blood pressure was 80/57 mmHg. She appeared comfortable without signs of respiratory distress. She received intravenous fluids and vasopressors, and was transferred to the intensive care unit. The patient had reported a previous coronavirus disease infection a few weeks prior. She was diagnosed and treated for multisystem inflammatory syndrome in adults. Intravenous immunoglobulin infusion was initiated and completed on hospital day 5. She was weaned off vasopressors by day 6, and discharged home on day 11. Conclusion Our case report is an example of the presentation, diagnosis, and management of multisystem inflammatory syndrome. Our research into previous case reports illustrates the wide range of presentations, degree of end organ damage, and treatment modalities. This diagnosis needs to be considered in the presence of recent coronavirus disease infection with new-onset end organ failure, as prompt diagnosis and treatment is crucial for better outcomes.

First confirmed case of multisystem inflammatory syndrome in adult in Egypt

“…After reviewing the literature, a large variety of management strategies and therapeutic approaches are suggested 12 . In the current study, the patient received broad‐spectrum antibiotics, steroids, vasopressors, immunomodulators (anakinra), and IVIG treatment in addition to fluid resuscitation.…”

“…At least four of the following criteria should exist: polymorphous rash excluding bullous or vesicular eruptions, conjunctival injection, oropharyngeal mucous membrane changes, extremity changes, and lymphadenopathy. Symptoms common to MIS‐C but not typical of classic Kawasaki disease include abdominal pain, which is often more severe than in classic Kawasaki disease; thrombocytopenia, anemia, and lymphopenia; and elevated levels of ferritin, troponin, and D‐dimer, 12 Septic shock: symptoms include fever, tachypnea, tachycardia, hypotension, and signs of tissue hypoperfusion. Its diagnosis is based on the recovery of the pathogen by culture. Scarlet fever: rash, fever, and lymphadenopathy are present.…”

SARS-CoV-2 Causes Lung Inflammation through Metabolic Reprogramming and RAGE

“…Seventy different systemic organ-specific disorders were identified to be associated with post-COVID-19 symptoms [ 51 ]. The mechanisms involved are not fully understood; however, most clinicians and researchers agree that inflammation is the number one reason for these long-term sequelae followed by the induction of hypoxia [ 52 , 53 , 54 , 55 ]. Both inflammation and hypoxia are the results of metabolic reprogramming (MR) caused by the virus and persist in patients, especially those with underlying diseases.…”

“…The molecular and cellular mechanisms leading to chronic inflammation remain unclear, and the cellular factor(s) implicated in the persistence of inflammation are also unknown. We hypothesize that SARS-CoV-2 mimics other viruses in reprogramming the metabolism resulting in chronic inflammation [ 55 ]. Several labs described that SARS-CoV-2 reprograms the metabolism to aid in viral replication [ 56 , 57 , 58 ].…”

Post-COVID Multisystem Inflammatory Syndrome-Adult Leading to Cardiomyopathy and Autoimmune Thyroiditis: A Case Report

“…A case series byMagro et al. in the year 2020 discusses the pathology of MIS-A with features of endotheliitis and deposition of complement in the vessels[8].According to Behzadi et al, in an article published in 2022, out of 36 reported MIS-A cases documented, 17 cases had COVID-19 infection confirmed via RT-PCR, antibody tests, and clinically[9]. In the case series published on October 2020 by Morris et al, it was found that a significant number of cases (8/27) of MIS-A had negative Polymerase Chain Reaction (PCR) and positive SARS CoV-2 antibody test results, thereby suggesting that MIS-A might represent a post-infectious process[7].…”