Multisystem inflammatory syndrome in an adult following the SARS-CoV-2 vaccine (MIS-V)

Abstract

SARS-CoV-2 vaccine roll-out has been successful in the UK and other parts of the world; however, there are increasing concerns about adverse events. A 44-year-old woman presented to a UK hospital with left upper arm pain at the vaccine site a couple of days after receiving the Pfizer-BioNTech mRNA vaccine, which progressed to fever, diarrhoea and abdominal pain over the next few days. She had an erythematous rash on the chest with subcutaneous oedema. Her C reactive protein was 539 mg/L, white cell count of 17×109/L (1.8–7.5), troponin-T of 1013 ng/L and creatine kinase of 572 u/L. She developed an unprovoked pulmonary embolism with acute kidney injury. After administration of intravenous methylprednisolone, the muscle oedema, skin rashes and acute kidney injury resolved. Although multisystem inflammatory syndrome (MIS) is described in children (MIS-C) and adults (MIS-A) following SARS-CoV-2 infection, we highlight the first reported MIS-V case after the SARS-CoV-2 vaccine.

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

“…The existing data regarding MIS-A suggest a similar convalescent response in adults [ 15 , 16 , 17 , 18 ]. Nevertheless, reports of a multisystem inflammatory syndrome after vaccination (MIS-V) in individuals who had received immunization after recovering from mild COVID-19, or perhaps non-neutralizing antibodies from other coronaviruses, suggest an alternative pathogenesis involving antibody enhancement that leads to the hyper-inflammatory syndrome [ 19 , 20 , 21 ].…”

Multisystem inflammatory syndrome in a male adolescent after his second Pfizer‐BioNTech COVID‐19 vaccine

“…However, 1 case of MIS after the Pfizer‐BioNTech mRNA vaccine has been described in a 44‐year‐old woman without a previous SARS‐CoV‐2 infection. 3 …”

Pathogenesis, Symptomatology, and Transmission of SARS-CoV-2 through Analysis of Viral Genomics and Structure

“…MIS-C has been associated with heart failure in some cases ( 127 ). A small number of case studies have identified presentations similar to MIS-C in adults associated with SARS-CoV-2 ( 128 – 131 ). However, not all cases of severe COVID-19 in children are characterizable as MIS-C. A recent study ( 132 ) described demographic and clinical variables associated with MIS-C in comparison with non-MIS-C severe acute COVID-19 in young people in the United States.…”