A case of multisystem inflammatory syndrome in an African adolescent male: case report

Moodley, Pramodhini; Tsitsi, J M L; Reddy, Denasha L.; Debising, Mohith; Ickinger, Claudia

doi:10.11604/pamj.2021.38.174.27910

Cited by 8 publications

(11 citation statements)

References 7 publications

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“…During the first quarter of 2020, similar observations of a hyper-inflammatory syndrome associated with SARS-CoV-2 were reported in adolescents and adults [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. The immunological host response to SARS-CoV-2 can lead to different recognizable immunological phenotypes, including the cytokine release syndrome (CRS) and the MIS-C or the multisystem inflammatory syndrome in adults (MIS-A).…”

Section: Introductionsupporting

confidence: 59%

Multisystem Inflammatory Syndrome Associated with SARS-CoV-2 Infection in an Adult: A Case Report from the Maldives

et al. 2021

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The multisystem inflammatory syndrome in adults (MIS-A) is a novel syndrome observed during COVID-19 outbreaks. This hyper-inflammatory syndrome is seen predominantly in children and adolescents. The case of an adult from the Maldives who had asymptomatic SARS-CoV-2 infection three weeks before presenting to the hospital with fever, rash, and shock is presented. De-identified clinical data were retrospectively collected to summarize the clinical progression and treatment during hospitalization and the six-month follow-up. SARS-CoV-2 infection was confirmed by RT-PCR. Other laboratory findings included anemia (hemoglobin: 9.8 g/dL), leukocytosis (leukocytes: 20,900/µL), neutrophilia (neutrophils: 18,580/µL) and lymphopenia (lymphocytes: 5067/µL), and elevated inflammatory markers, including C-reactive protein (34.8 mg/dL) and ferritin (2716.0 ng/dL). The electrocardiogram had low-voltage complexes, and the echocardiogram showed hypokinesia, ventricular dysfunction, and a pericardial effusion suggestive of myocardial dysfunction compromising hemodynamics and causing circulatory shock. These findings fulfilled the diagnostic criteria of MIS-A. The case was managed in the intensive care unit and required non-invasive positive pressure ventilation, inotropes, and steroids. With the new surges of COVID-19 cases, more cases of MIS-A that require the management of organ failure and long-term follow-up to recovery are anticipated. Clinicians should therefore be vigilant in identifying cases of MIS-A during the pandemic.

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Section: Introductionsupporting

confidence: 59%

Multisystem Inflammatory Syndrome Associated with SARS-CoV-2 Infection in an Adult: A Case Report from the Maldives

et al. 2021

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“…Multi-system in ammatory syndrome in children (MIS-C) emerged in 2020 as a serious paediatric manifestation of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has been described throughout the world [1][2][3][4]. MIS-C is reported in less resourced settings [5][6][7][8] but there are very few reports from Africa [9][10][11]. The incidence of a child developing MIS-C after exposure to SARS-CoV-2 is not well known as exposure rates to SARS-CoV-2 in children are largely unknown.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Features and Estimated Incidence of MIS-C in Cape Town, South Africa

Butters

Abraham

Stander

et al. 2022

Preprint

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Background Multisystem inflammatory syndrome is a severe manifestation of SARS-CoV-2 in children. The incidence of MIS-C after infection is poorly understood. There are very few cohorts describing MIS-C in Africa despite MIS-C being more common in Black children worldwide. Methods A cohort of children with MIS-C and healthy children was recruited from May 2020 until May 2021 from the two main paediatric hospitals in Cape Town, South Africa. Clinical and demographic data were collected, and serum was tested for SARS-CoV-2 antibodies. The incidence of MIS-C was calculated using an estimation of population exposure from seroprevalence in the healthy group. Summary data, non-parametric comparisons and logistic regression analyses were performed. Results 68 children with MIS-C were recruited with a median age of 7 years (3.6, 9.9). 97 healthy children were recruited with a 30% seroprevalence. The estimated incidence of MIS-C was 22/100 000 exposures in the city in this time. Black children were over-represented in the MIS-C group (62% vs 37%, p=0.002). The most common clinical features in MIS-C were fever (100%), tachycardia (98.5%), rash (85.3%), conjunctivitis (77.9%), abdominal pain (60.3%) and hypotension (60.3%). The median haemoglobin, sodium, neutrophil count, white cell count, CRP, ferritin, cardiac (pro-BNP, trop-T) and coagulation markers (D-dimer and fibrinogen) were markedly deranged in MIS-C. Cardiac, pulmonary, central nervous and renal organ systems were involved in 71%, 29.4%, 27.9% and 27.9% respectively. 94.1% received intravenous immune globulin, 64.7% received methylprednisolone and 61.7% received both. 39.7% required ICU admission, 38.2% required inotropic support, 38.2% required oxygen therapy, 11.8% required invasive ventilation and 6% required peritoneal dialysis. Older age was an independent predictor for the requirement for ionotropic support (OR=1.523, CI 1.074, 2.16, p=0.018). The median hospital stay duration was 7 days with no deaths. Conclusion The lack of reports from Southern Africa does not reflect a lack of cases of MIS-C. MIS-C poses a significant burden to children in the region as long as the pandemic continues. MIS-C disproportionately affects black children. The clinical manifestations and outcomes of MIS-C in this region highlight the need for improved surveillance, reporting and data to inform diagnosis and treatment.

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“…IV methylprednisolone and IVIg have been proposed and used as initial treatment options for MIS-C 6 25 29 30. MIS-A has been successfully treated with either or both of the agents, with the majority of patients surviving and demonstrating a return to premorbid function at later review 7–9 11–14 17 20.…”

Section: Discussionmentioning

confidence: 99%

“…Our patient showed a rapid improvement in clinical condition and inflammatory markers on initiation of combination therapy with glucocorticoids and IVIg. Tocilizumab, a monoclonal antibody directed against the interleukin 6 receptor, has also been used in some reports 8 9 11 12 29. Although tocilizumab is available in our facility, there is still little evidence to support its use in MIS-A.…”

Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome in an adult (MIS-A) due to SARS-CoV-2 infection presenting to a South African hospital

et al. 2022

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Kawasaki-like multisystem inflammatory syndrome related to SARS-CoV-2 infection is a well-described condition in children and adolescents (MIS-C) and now also in adults (MIS-A). We report a case of MIS-A in a previously well woman in her mid-30s who presented with vasopressor-dependent shock 2 weeks after initial recovery from suspected SARS-CoV-2 infection, accompanied by fever, vomiting, diarrhoea, weakness, arthralgia, rash, cough and headache. Examination was notable for fever, tachycardia, hypotension, cervical lymphadenopathy, mucocutaneous involvement, neck stiffness, pansystolic murmur and bilateral crepitations. Inflammatory markers were elevated. Echocardiogram showed mitral regurgitation with preserved ejection fraction. She was treated with vasopressors, admitted to the intensive care unit and subsequently required invasive mechanical ventilation. Both PCR and antibodies for SARS-CoV-2 were positive. Treatment with intravenous methylprednisolone and intravenous immunoglobulin was initiated with rapid improvement in clinical condition and inflammatory markers. She has since made a full recovery with normal echocardiogram 8 months later.

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A case of multisystem inflammatory syndrome in an African adolescent male: case report

Cited by 8 publications

References 7 publications

Multisystem Inflammatory Syndrome Associated with SARS-CoV-2 Infection in an Adult: A Case Report from the Maldives

Multisystem Inflammatory Syndrome Associated with SARS-CoV-2 Infection in an Adult: A Case Report from the Maldives

The Clinical Features and Estimated Incidence of MIS-C in Cape Town, South Africa

Multisystem inflammatory syndrome in an adult (MIS-A) due to SARS-CoV-2 infection presenting to a South African hospital

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