Multisystem Inflammatory Syndrome in Adults

Tenforde, Mark W; Morris, Sapna Bamrah

doi:10.1016/j.chest.2020.09.097

Cited by 32 publications

(35 citation statements)

References 14 publications

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“…A subset of patients with COVID-19 and hyperinflammation may present with a multisystemic inflammatory syndrome (MIS), with symptoms overlapping with Kawasaki disease and frequently showing signs of cardiac dysfunction [29][30][31]. MIS-C was originally described in pediatric patients, but a similar multisystem inflammatory syndrome in adults (MIS-A) has been described with edematous myocarditis, frequently requiring intensive care and aminergic support [32][33][34]. Both adult patients who died in our series had evidence of hyperinflammation, but none had evidence of MIS-A.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in the Context of Inborn Errors of Immunity: a Case Series of 31 Patients from Mexico

Castaño-Jaramillo¹,

Yamazaki‐Nakashimada²,

O’Farrill-Romanillos

et al. 2021

J Clin Immunol

126

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Highlights1. What is already known about this topic? SARS-CoV-2 causes asymptomatic or mild infection in about 80% of humans, while an excessive immune response has killed millions. Differential susceptibility and risk factors became a concern early in the pandemic. Several monogenic defects that involve innate viral sensors or affect interferon response pathways, as well as autoantibodies against type 1 interferons, have been identified in 14% of patients with life-threatening COVID-19. The impact of the novel betacoronavirus infection in patients with known inborn errors of immunity is less clear. Case series and reports from different countries have suggested a minor impact or even a potential protective effect of the IEI for some patients.2. What does this article add to our knowledge? We describe findings and outcomes of COVID-19 in 31 pediatric and adult patients with known IEI from Mexico, 84% of whom survived. Pediatric patients had a higher hospitalization rate. Inpatient mortality was 40%, and ICU mortality was 63%. Six patients died of secondary bacterial infection or uncontrolled systemic inflammation, but not from overwhelming viral infection. One patient with an autoinflammatory disorder under treatment with anakinra had a catastrophic clinical course. Eighty percent of patients received IVIG as part of their treatment for acute SARS-CoV-2 infection.3. How does this study impact current management guidelines? We recommend continued and/or high-dose IVIG in patients with known IEI seeking care for COVID-19. Patients with autoinflammatory disorders, especially those with inflammasome dysregulation, should probably take extreme measures to prevent exposure, while doctors taking care of SARS-CoV-2 infected patients with immune deficiencies must do everything they can to prevent secondary bacterial infections. The high survival of patients with COVID-19 in the context of inborn errors of immunity worldwide (over 80%) might be the result of patientphysician awareness and special care.

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Section: Discussionmentioning

confidence: 99%

COVID-19 in the Context of Inborn Errors of Immunity: a Case Series of 31 Patients from Mexico

Castaño-Jaramillo¹,

Yamazaki‐Nakashimada²,

O’Farrill-Romanillos

et al. 2021

J Clin Immunol

126

View full text Add to dashboard Cite

show abstract

“…Atrial flutter onset is associated with an elevated risk of mortality, so immediate recognition and treatment are required [32]. We chose to present this case in order to highlight that the symptomatology in adolescents with MIS-C can be more severe, with multiorgan dysfunction, as described in COVID19-related multisystem inflammatory syndrome in adults [41].…”

Section: Case Particularitiesmentioning

confidence: 99%

The Challenging Diagnosis of Pediatric Multisystem Inflammatory Syndrome Associated with Sars-Cov-2 Infection-Two Case Reports and Literature Review

Ionescu

Taras

Dombici

et al. 2021

JPM

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Severe acute respiratory coronavirus 2 (SARS-CoV-2) is a novel coronavirus discovered in 2019 that caused the coronavirus disease 2019 (COVID19). During the last year, over 70 million people were infected and more than 1.5 million people died. Despite the tremendous number of people infected, children were less affected and presented milder forms of the disease. A short time after the pandemic was declared, a new hyperinflammatory syndrome resembling Kawasaki disease (KD) was described in children with confirmed or suspected SARS-CoV-2 infection named multisystem inflammatory syndrome in children (MIS-C). The incidence of MIS-C is low and it has a polymorphous clinical presentation, making the diagnosis difficult. Although the incidence is reduced, there is a high risk of cardiovascular complications. In order to raise awareness, we present the cases of two pediatric patients diagnosed with MIS-C in our clinic.

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“…MIS-A after COVID-19 is a postinfectious inflammatory syndrome that tends to present several weeks after recovering from COVID-19 infection. [1][2][3] MIS-A, although poorly understood, is characterized by fever, markedly elevated inflammatory biomarkers, and multiple organ system involvement. Cardiac injury and shock are common, with elevated cardiac biomarkers, left ventricular dysfunction, coronary dilatation, and a requirement for vasopressor or inotrope support.…”

Section: Multisystem Inflammatory Syndrome In Adults (Mis-a) Associated With Recent Severe Acute Respiratory Syndrome Coronavirus 2 Infecmentioning

confidence: 99%