Multisystem inflammatory syndrome-related refractory cardiogenic shock in adults after coronavirus disease 2019 infection: a case series

Abstract

Background A novel multisystem inflammatory syndrome in children (MIS-C) temporally associated with the coronavirus disease 2019 (COVID-19) infection has been reported, arising weeks after the peak incidence of COVID-19 infection in adults. Patients with MIS-C have been reported to have cardiac involvement and clinical features overlapping with other acute inflammatory syndromes such as Kawasaki-Disease, toxic shock syndrome, and macrophage activation syndrome. MIS-C may follow Covid-19 infection, most of the time after its asymptomatic form, even though it can lead to serious and life-threatening illness. Case summary In this case series, we discuss two cases of young adults with no former medical history who fit with the criteria defined in MIS-C. They both developed a refractory cardiogenic shock and required intensive care treatment including mechanical circulatory support, specifically the use of venous-arterial extracorporeal membrane oxygenation (VA-ECMO). They were both treated early with intravenous immune globulin and adjunctive high-dose steroids. They recovered ad integrum in less than two weeks. Discussion MIS-C occurs 2 to 4 weeks after infection with SARS-CoV-2. Patients with MIS-C should ideally be managed in an intensive care environment since rapid clinical deterioration may occur. It would be preferable to have a multi-disciplinary care to improve outcomes. Patients should be monitored for shock. Elucidating the mechanism of this new entity may have importance for understanding COVID-19 far beyond the patients who have had MIS-C to date. The pathogenesis seems to involve post-infectious immune dysregulation so early administration intravenous immune globulin associated to corticosteroids appears appropriate. It implies early recognition of the syndrome even in young adults.

The First Case in Japan of Fulminant Myocarditis Due to Multisystem Inflammatory Syndrome in Children (MIS-C) That Required Mechanical Circulatory Support

“…EMB of patients with MIS-C is limited. 5,8,9) These limited reports revealed that the immune cells infiltrating the myocardium included T lymphocytes and macrophages, as in our case. However, those with MIS-A (adult) revealed not only lymphocytic myocarditis but also eosinophilic and mixed-cell myocarditis.…”

Multi-Inflammatory Syndrome in Children (MIS-C) in 2023: Is It Time to Forget about It?

“…Unfortunately, MIS-C criteria are not very specific and it has been suggested that only a small proportion of children with the most severe manifestations of acute COVID-19 may satisfy them. Finally, MIS-C has, although very rarely, also been described in adults [ 20 , 21 , 22 , 23 , 24 , 25 ]. This narrative review aims to analyze the new evidence relating to MIS-C, particularly regarding the change in its incidence, the link between MIS-C and the anti-SARS-CoV-2 vaccine, and its treatment.…”