SARS-CoV-2-Induced Multisystem Inflammatory Syndrome in a Young Adult: Case Report

Abstract

We describe a case of a previous healthy 20-year-old male athlete who presented with an atypical clinical profile with multiorgan involvement within five weeks after confirmed SARS-CoV-2 infection, suggestive for multisystem inflammatory syndrome (MIS); MIS is a rare, potentially life-threatening complication associated with SARS-CoV-2. MIS shares similar clinical features compatible with several overlapping lifethreatening hyperinflammatory syndromes, such as incomplete Kawasaki Disease (KD) and toxic shock syndrome (TSS) associated to a cytokine storm suggestive of a macrophage activation syndrome (MAS) without fulfilling the criteria for hemophagocytic lymphohistiocytosis (HLH), that may create a great challenge to distinguish between them. MIS should promptly be considered and treated, as uncontrolled MIS has a high mortality.In MIS cardiac involvement, heart failure may present as an additional problem, especially because volume loading is advised in accordance with proposed therapy. Carefully monitoring of the respiratory and cardiac status in response of resuscitation is therefore warranted.

The Impact of COVID-19 on the Cardiovascular Health of Emerging Adults Aged 18-25: Findings From a Scoping Review

“…In this review, 47 cases (mean age=21; 70% male) of emerging adults with cardiovascular complications in the context of confirmed or suspected hyperinflammatory syndromes and active or previous COVID-19 were identified. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 If not concomitant COVID-19, previous infections typically occurred 3-8 weeks prior to onset of symptoms. 23 , 30 , 32 , 33 , 34 , 40 , 43 , 44 , 45 , 46 , 52 , 53 , 56 Alongside MIS-C/A, cardiovascular presentations/complications included ventricular dysfunction (n=33), tachycardia (n=28), hypotension (n=16), cardiogenic shock (n=14), cardiomyopathy (n=11), including myocarditis and pericarditis, valve insufficiency (n=4), atrial fibrillation (n=2), and non-ST-elevation myocardial infarction (n=2); refer to Supplemental Table S2 for additional case details.…”

“… 148 In the cohort study by Belay et al 148 , mainstay treatments for MIS included intravenous immunoglobulin (IVIG) and steroids. Across the 47 cases included in this review 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 70% (n=33) were treated with steroids (e.g. methylprednisolone, prednisolone, prednisone) and 62% (n=29) with IVIG.…”

Hyperinflammatory syndrome in a paediatric patient with a recent diagnosis of HIV/AIDS infection: hemophagocytic lymphohistiocytosis or immune reconstitution syndrome?

“…In some pathological conditions, the systemic inflammatory response is not correctly counter-regulated and once it is triggered it cannot be normally contained and switched off. After COVID-19 pandemics we have witnessed the emergence of multisystem inflammatory syndrome in children (MIS-C), a rare post-infectious hyperinflammatory disorder associated with SARS-CoV-2 [ 1 ]. This disorder may also have overlapping features with Kawasaki disease (KD), hemophagocytic lymphohistiocytosis (HLH), and toxic shock syndrome (TSS).…”

Pediatric COVID-TB: A Clinical Perspective Based on the Analysis of Three Cases

“…Gastrointestinal (GI) symptoms are also described; a systematic review showed rates of vomiting of 4-9%, diarrhea of 6-13%, and abdominal pain in approximately 4% of infected patients [4]. After the COVID-19 pandemic, we have witnessed the emergence of multisystem inflammatory syndrome in children (MIS-C), a rare post-infectious hyperinflammatory disorder associated with SARS-CoV-2 [5]. This syndrome indicates that the symptoms of SARS-CoV-2 infection are closely related to the status of the host; indeed, the treatment and prognosis of these inflammatory diseases have not yet been clarified.…”