ABSTRACT
Multisystem inflammatory syndrome (MIS) is a severe inflammatory response that occurs days to weeks following the infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19). Initially known in children and named MIS-C, recently several cases of MIS in adults have been reported to the Centers for Disease Control and Prevention (CDC), leading to the recognition of a new disease MIS in adults (MIS-A). The current treatment options include high-dose steroids, intravenous immunoglobulin (IVIG), and immunosuppressive therapy. However, the pharmacologic approach remains limited to case reports and pending official guidelines to treat cases with MIS-A. We present a case of an adult patient who had a severe inflammatory state following COVID-19 infection, who was treated with IL-1 antagonist therapy with a successful outcome.
ABSTRACT
With a large number of coronavirus disease 2019 (Covid-19) patients being discharged from hospital with negative test results for SARS-CoV-2, it has been reported that several recovered cases tested positive after discharge (re-positive, RP). This finding has raised several important questions for this novel coronavirus and Covid-19 disease. In this review, we have discussed several important questions, including: (1) Can the virus re-infect recovered individuals? (2) What are the possible causes of the re-positive reverse transcriptase-polymerase chain reaction (RT-PCR) test in recovered patients? (3) What are the implications of these re-positive cases concerning the spread of the virus? Understanding how recovery from Covid-19 confers immunity to decrease the risk of re-infection is needed to inform current efforts to safely scale back population-based interventions, such as physical distancing. We have also described what is currently known about the immune response to Covid-19, highlighted key gaps in knowledge, and identified opportunities for future research. Overall, the quality of the evidence is poor and we describe the features that should be described for future cases.