COVID-19 multisystemic inflammatory syndrome in adults: a not to be missed diagnosis

Tung‐Chen, Yale; Algora-Martín, Ana; Rodríguez-Roca, Sonia; Santiago, Alberto Díaz de

doi:10.1136/bcr-2021-241696

Cited by 11 publications

(15 citation statements)

References 10 publications

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“…Gastrointestinal symptoms were less frequently reported: nausea (7/36, 19%), abdominal pain (11/36; 30%), vomiting (5/36; 13%), and diarrhea (7/36; 19%). Like our case report, sore throat was present in five patients (5/36; 14%) [4][5][6][7][8] and unilateral cervical pain/swelling in four other cases (6/36; 16%) [8][9][10][11][12]. Some patients had predominant visual symptoms [5,[13][14][15][16][17].…”

Section: Discussionsupporting

confidence: 68%

“…Specifically, tachycardia (22/36; 61%) and hypotension/cardiogenic shock with documented impaired ejection fraction (23/36; 64%) [5-8, 10, 12, 15, 17-24]. The left ventricular function/ejection fraction normalized with treatment in 15 patients [6,7,12,17,21,23,24], of whom 7 patients received IVIG with or without aspirin [10,12,17,23,24]. Overall, 28/36 (78%) patients recovered and were safely discharged.…”

Section: Discussionmentioning

confidence: 99%

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

2022

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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.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

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

2022

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“…A total of 221 patients with MIS-A were identified: 102 were from the CDC’s MIS-C surveillance system, of whom 55 were described in a recent publication 3 ; 20 were from voluntary reports to the CDC, of whom 9 were included in a recent publication 2 ; and 99 were from case reports published in the literature. 2 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 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 , 57 , 58 , 59 , …”

Section: Resultsmentioning

confidence: 99%

“…In total, 449 relevant articles were identified, and 86 were selected for in-depth review; of these, 60 had data for patients with MIS-A. 2 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 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 , 57 , 58 , 59 , 60 , 61 , 62 , 63 Figure 1 summarizes...…”

Section: Methodsmentioning

confidence: 99%

Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults

et al. 2021

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Key Points Question What are the clinical characteristics of multisystem inflammatory syndrome in adults (MIS-A)? Findings This systematic review of patients with MIS-A reported in the literature and to the US Centers for Disease Control and Prevention identified 221 patients worldwide. The syndrome presented approximately 4 weeks after acute COVID-19 with hyperinflammation and extrapulmonary multiorgan involvement that may be difficult to discern from acute biphasic COVID-19 and postacute sequelae of SARS-CoV-2 infection. Meaning These findings suggest that MIS-A occurs in the postacute COVID-19 period with a heterogeneous clinical presentation likely owing to a dysregulated immune response.

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“…Therefore, the clinical manifestations, the role of SARS-CoV-2 infection and the pathophysiological mechanisms of MIS-C are still unknown. In this sense, it is still uncertain whether the symptoms are due to post-infectious hyper-inflammation, autoinflammatory or autoimmune disease ( 17 , 21 , 22 ).…”

Section: Mis-cmentioning

confidence: 99%

Multisystem Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Role of Oxidative Stress

et al. 2021

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With the appearance of the SARS-CoV-2 virus in December 2019, all countries in the world have implemented different strategies to prevent its spread and to intensively search for effective treatments. Initially, severe cases of the disease were considered in adult patients; however, cases of older school-age children and adolescents who presented fever, hypotension, severe abdominal pain and cardiac dysfunction, positive for SARS-CoV-2 infection, have been reported, with increased pro-inflammatory cytokines and tissue damage, condition denominated multisystemic inflammatory syndrome (MIS-C); The emerging data from patients with MIS-C have suggested unique characteristics in the immunological response and also clinical similarities with other inflammatory syndromes, which can support as a reference in the search for molecular mechanisms involved in MIS-C. We here in propose that oxidative stress (OE) may play a very important role in the pathophysiology of MIS-C, such as occurs in Kawasaki disease (KD), severe COVID-19 in adults and other processes with characteristics of vascular damage similar to MIS- C, for which we review the available information that can be correlated with possible redox mechanisms.

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COVID-19 multisystemic inflammatory syndrome in adults: a not to be missed diagnosis

Cited by 11 publications

References 10 publications

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

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

Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults

Multisystem Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Role of Oxidative Stress

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