Multisystem inflammatory syndrome with refractory cardiogenic shock due to acute myocarditis and mononeuritis multiplex after SARS-CoV-2 infection in an adult

Othenin-Girard, Alexandra; Regamey, Julien; Lamoth, Frédéric; Horisberger, Alice; Glampedakis, Emmanouil; Epiney, Jean-Benoît; Küntzer, Thierry; Leval, Laurence de; Carballares, Maude; Hurni, Claire‐Anne; Rusca, Marco; Pantet, Olivier; Bernardo, Stefano Di; Oddo, Mauro; Comte, Denis; Piquilloud, Lise

doi:10.4414/smw.2020.20387

Cited by 31 publications

(40 citation statements)

References 16 publications

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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%

“…Nine of 195 patients (5%) experienced arterial or venous thrombosis. One patient reported in the literature 16 had severe mononeuritis multiplex, affecting the right median and facial nerves and both ulnar, tibial, peroneal, and sural nerves, in addition to myocarditis and cardiogenic shock.…”

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%

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults

et al. 2021

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“…The results of the biopsy allowed the team to de-escalate steroid therapy and narrow our diagnosis to MIS-A. To date, this is the first case reported in the literature when the diagnosis of MIS-A was made on EMB as histology was not consistent with myocarditis [ 5 – 7 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiogenic shock complicating multisystem inflammatory syndrome following COVID-19 infection: a case report

Gurin

Lin

Bernard

et al. 2021

BMC Cardiovasc Disord

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Background With the high prevalence of COVID-19 infections worldwide, the multisystem inflammatory syndrome in adults (MIS-A) is becoming an increasingly recognized entity. This syndrome presents in patients several weeks after infection with COVID-19 and is associated with thrombosis, elevated inflammatory markers, hemodynamic compromise and cardiac dysfunction. Treatment is often with steroids and intravenous immunoglobulin (IVIg). The pathologic basis of myocardial injury in MIS-A, however, is not well characterized. In our case report, we obtained endomyocardial biopsy that revealed a pattern of myocardial injury similar to that found in COVID-19 cardiac specimens. Case presentation A 26-year-old male presented with fevers, chills, headache, nausea, vomiting, and diarrhea 5 weeks after his COVID-19 infection. His SARS-CoV-2 PCR was negative and IgG was positive, consistent with prior infection. He was found to be in cardiogenic shock with biventricular failure, requiring inotropes and diuretics. Given concern for acute fulminant myocarditis, an endomyocardial biopsy (EMB) was performed, showing an inflammatory infiltrate consisting predominantly of interstitial macrophages with scant T lymphocytes. The histologic pattern was similar to that of cardiac specimens from COVID-19 patients, helping rule out myocarditis as the prevailing diagnosis. His case was complicated by persistent hypoxemia, and a computed tomography scan revealed pulmonary emboli. He received IVIg, steroids, and anticoagulation with rapid recovery of biventricular function. Conclusions MIS-A should be considered as the diagnosis in patients presenting several weeks after COVID-19 infection with severe inflammation and multi-organ involvement. In our case, EMB facilitated identification of MIS-A and guided therapy. The patient’s biventricular function recovered with IVIg and steroids.

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“…Nasopharyngeal swab samples were tested for SARS-CoV-2 PCR yielded negative results, and the blood sample tested for SARS CoV-2 IgM + IgG antibody yielded positive results. There was no pathological sign on chest CT. A little amount of free liquid was detected in the pelvic region and among some parts of small intestine on abdomen CT. After obtaining blood, urine, and stool samples for cultures, Hékimian et al [12] Hékimian et al [12] Hékimian et al [12] Hékimian et al [12] Hékimian et al [12] Hékimian et al [12] Hékimian et al [12] Moghadam et al [13] Age ( [16] Ahsan et al [17] Malangu et al [18] Gulersen et al [19] Vieira et al [5] Razavi et al [20] Age ( Riollano-Cruz et al [21] Riollano-Cruz et al [21] Othenin-Girard [22] Parker [23] Parker [23] Kaushik et al [24] Kaushik et al [24] Chérif et al [25] Downing et al [26] Shan et al [27] Age empirical ceftriaxone 2 gr/day was started. On the follow up, hypotension, tachycardia, and hypoxia developed on the first day of treatment, and procalcitonin, troponin, and pro-BNP levels were found increased.…”

Section: Casementioning

confidence: 99%

Multiple system inflammatory syndrome associated with SARS-CoV-2 infection in an adult and an adolescent

et al. 2021

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Multisystem inflammatory syndrome in adults (MIS-A) is a new syndrome related with COVID-19. A case-based review was performed to present real-life experiences in terms of main findings and treatment options. We described two cases with the diagnosis of MIS and searched the literature to review all reported ≥ 18-year-old cases. The PubMed, Scopus, and Web of Science databases were searched. All relevant articles from January 2020 to February 2021 were reviewed. An adolescent and an adult patient (18 and 40 years-old, respectively) with the diagnosis of MIS were presented. Both had the consistent clinical findings with the case definition criteria. Although steroid, intravenous immunoglobulin (IVIG) and supportive care treatments have been suggested in the literature, there exists no treatment guideline for MIS-A. The clinical and laboratory findings of the patients progressively improved with the implementation of the IVIG and the pulse steroid treatments. A total of 51 cases (≥ 18 years-old) with MIS were analyzed. Mean age was 29.4 ± 10 years. Fever (80.4%), gastrointestinal (72.5%), and respiratory symptoms (54.9%) were the predominant symptoms. Cardiovascular abnormalities were the most frequent reported findings (82.4%, 42/51). The dermatological and conjunctival findings were reported in 39.2% and 35.3% of the patients, respectively. The increased level of inflammatory biomarkers was remarkable. Most of the patients were treated successfully with steroid and IVIG. Clinicians managing adult patients should keep in mind the development risk of MIS related with SARS-CoV-2 infection to perform necessary interventions properly without delay. IVIG and pulse steroid treatments are the effective options on clinical improvement.

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Multisystem inflammatory syndrome with refractory cardiogenic shock due to acute myocarditis and mononeuritis multiplex after SARS-CoV-2 infection in an adult

Cited by 31 publications

References 16 publications

Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults

Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults

Cardiogenic shock complicating multisystem inflammatory syndrome following COVID-19 infection: a case report

Multiple system inflammatory syndrome associated with SARS-CoV-2 infection in an adult and an adolescent

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