Post-COVID multisystem inflammatory syndrome in adults: a study from a tertiary care hospital in south India

Abstract

Background & objectives: There are limited data from India on the post-COVID multisystem inflammatory syndrome in adults (MIS-A). The objective of the present study was to evaluate the clinical profile of patients with MIS-A admitted to a tertiary care centre in southern India. Methods: This single-centre retrospective study was conducted from November 2020 to July 2021, and included patients aged >18 yr admitted to the hospital as per the inclusion and exclusion criteria. Results: Nine patients (5 male, mean age 40±13 yr) met the criteria for MIS-A. Five patients had proven COVID-19 infection or contact history 36.8±11.8 days back. All patients were positive for SARS-CoV-2 IgG antibody, negative for COVID-19 PCR, and had negative blood, urine and sputum cultures. All patients had fever and gastrointestinal (GI) symptoms, and five patients had left ventricular dysfunction. All patients had neutrophilic leucocytosis at presentation and elevated biomarkers such as C-reactive protein serum procalcitonin, D-dimer and ferritin. The majority of the patients (7/9 i.e . 77.78%) were treated with intravenous hydrocortisone (50-100 mg q6h-q8h). Six patients recovered completely whereas three patients expired. Interpretation & conclusions: Fever and GI symptoms were the most common presentation of MIS-A. Elevated serum procalcitonin may not be useful in differentiating bacterial sepsis from MIS-A. Most patients responded to corticosteroids.

Multisystem inflammatory syndrome in adult with features of Kawasaki disease

“…Although the children counterpart of MIS‐A typically occurs within 2–6 weeks post COVID‐19 infection, 6–8 MIS‐A may occur up to 4 months after‐COVID‐19 infection as seen in our patient. Existing literature suggests that early treatment with IVIG, high‐dose prednisolone 8 and interleukin‐6 blockade results in rapid improvement in clinical condition and inflammatory markers 9 . The use of aspirin in MIS‐A is reported in some case reports 10,11 .…”

“…MIS‐A, like its paediatric counterpart (MIS‐C), can present very similarly to KD, with florid mucocutaneous rashes and sometimes with cardiogenic shock requiring inotropic support 3–5 . Although the children counterpart of MIS‐A typically occurs within 2–6 weeks post COVID‐19 infection, 6–8 MIS‐A may occur up to 4 months after‐COVID‐19 infection as seen in our patient. Existing literature suggests that early treatment with IVIG, high‐dose prednisolone 8 and interleukin‐6 blockade results in rapid improvement in clinical condition and inflammatory markers 9 .…”

Concomitant Cytomegalovirus Viraemia in Multisystem Inflammatory Syndrome in Adults (MIS-A) following COVID-19

“…MIS-A predominantly affects males between 30 and 50 years of age. The most common presenting symptoms are fever and gastrointestinal symptoms, as in our patient [ 8 ]. Cardiac involvement is frequent but is not universally present, as evidenced by a recent systematic review and as observed in our case, in which there was no cardiac involvement [ 4 ].…”

Is procalcitonin elevation always an indicator of bacterial infection?

“…For example, a recently published observational study found increased PCT in patients with postCOVID-19 (coronavirus disease 2019) multisystem inflammatory syndrome. [ 11 ] Yu et al[ 12 ] found that the main cause was rhabdomyolysis in a patient who was followed up with the assumption of sepsis and whose PCT values increased considerably. PCT was found to be high in the acute period of Kawasaki disease in children, particularly in those who were resistant to intravenous immunoglobulin therapy.…”