Histopathologic correlation of skin manifestations of multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection

So, Naomi; So, Jodi; Centkowski, Sierra; Rana, Jasmine; Aleshin, Maria; Kwong, Bernice Y.; Rieger, Kerri E.; Zaba, Lisa C.; Chiou, Albert S.

doi:10.1016/j.jdcr.2021.06.031

Cited by 6 publications

(7 citation statements)

References 3 publications

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“…A similar, annular rash has been previously described in a patient with MIS-A and heart failure [ 33 ]. Histopathological examinations of skin lesions in children have shown perivascular inflammation with the infiltration of lymphocytes [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…Morris et al described 16 patients meeting criteria for MIS-A and five with cutaneous manifestations, most notably mucositis, during hospital admission [ 38 ]. Additionally, So et al described two patients with urticarial macules and plaques [ 40 ].…”

Section: Multisystem Inflammatory Syndrome In Adults (Mis-a)mentioning

confidence: 99%

“…Skin biopsy demonstrated superficial perivascular lymphocytic infiltrate with rare neutrophils and extravasated erythrocytes with negative in situ hybridization for SARS-CoV-2 spike protein in a patient with urticarial macules and patches; similarly, another biopsy showed superficial and deep perivascular and periadnexal lymphocytic infiltrate with negative in situ hybridization for SARS-CoV-2 in a different patient with urticarial plaques [ 40 ].…”

Section: Multisystem Inflammatory Syndrome In Adults (Mis-a)mentioning

confidence: 99%

“…Some required vasopressors, extracorporeal membrane oxygenation, endotracheal intubation, and ventilation. The treatments for MIS-A secondary to SARS-CoV-2 infections include IVIG, corticosteroids, and tocilizumab, an interleukin-6 inhibitor, in addition to intensive care support when needed [ 38 , 40 ].…”

Section: Multisystem Inflammatory Syndrome In Adults (Mis-a)mentioning

confidence: 99%

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Cutaneous Manifestations of SARS-CoV-2 Infection

et al. 2022

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the coronavirus disease 2019 (COVID-19) pandemic, affecting people worldwide. SARS-CoV-2 infection is a multisystem disease with potential for detrimental effects on various systemic organs. It affects people of all ages with varying degrees of disease severity. Patients with SARS-CoV-2 infection commonly present with dry cough, fever, and fatigue. A clinical spectrum of skin findings secondary to SARS-CoV-2 has also been reported. The most common cutaneous patterns associated with COVID-19 are chilblain-like lesions (CBLL), maculopapular lesions, urticarial lesions, vesicular lesions, and livedoid lesions. Other skin findings secondary to SARS-COV-2 infection are erythema multiforme (EM)-like lesions and skin findings associated with multisystem inflammatory syndrome in children (MIS-C) and rarely multisystem inflammatory syndrome in adults (MIS-A). Physician awareness of skin manifestations of SARS-CoV-2 infection can help with early identification and treatment. This narrative review provides an update of various skin manifestations reported with SARS-CoV-2 infection, including clinical presentation, proposed pathogenesis, histopathology, prognosis, and treatment options.

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“…Skin biopsies in two patients reported by So et al . 21 demonstrated nonspecific histological findings of perivascular dermatitis with negative in situ hybridization for SARS‐CoV‐2 spike protein. Lesional direct immunofluorescence was also negative, which is consistent with patterns commonly observed in viral exanthems.…”

Section: Features Of Multisystem Inflammatory Syndrome In Adultsmentioning

confidence: 99%

Mucocutaneous manifestations of COVID-19-related multisystem inflammatory syndrome in adults: an update

Sil

Das

Datta³

2022

Clinical and Experimental Dermatology

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Multisystem inflammatory syndrome in adults (MIS‐A) is an inflammatory condition that affects multiple extrapulmonary organ systems (cardiac, gastrointestinal tract, dermatological and/or neurological), attributed to a postinfectious and atypical complication occurring weeks to months after infection with severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2). The diagnosis is primarily based on findings encompassing persistent fever, elevated inflammatory markers, multiorgan involvement and a temporal relationship with COVID‐19 infection. The existing literature on MIS‐A, although growing, is limited to case reports and small case series. It is imperative that dermatologists be aware of this entity and aid the critical care team to ensure timely diagnosis and early therapeutic intervention. In this review, we concisely highlight the varied presentations, pathogenesis and treatment options in MIS‐A.

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Histopathologic correlation of skin manifestations of multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection

Cited by 6 publications

References 3 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

Cutaneous Manifestations of SARS-CoV-2 Infection

Mucocutaneous manifestations of COVID-19-related multisystem inflammatory syndrome in adults: an update

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