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1.
J Community Hosp Intern Med Perspect ; 12(4): 7-13, 2022.
Article in English | MEDLINE | ID: covidwho-2081653

ABSTRACT

Multisystem inflammatory syndrome is a life-threatening condition associated with elevated inflammatory markers and multiple organ injury. A diagnosis of exclusion, it has been reported after severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) in children and adults; recently it has been described in some post-COVID-19 vaccinated individuals. The prognosis with supportive care and immunomodulatory therapy is good, although some individuals may require treatment in the intensive care unit (ICU). Here we report a case of a 58-year-old man who developed multi-organ failure after receiving the second dose of the Moderna mRNA-1273 COVID-19 vaccine. He required critical organ support in the ICU. An extensive workup was done to rule out alternative infectious and inflammatory processes. Following a period of gradual in-hospital convalescence, our patient made a full recovery. To our knowledge, this is the first comprehensively described case of multisystem inflammatory syndrome associated with Moderna mRNA-1273 COVID-19 vaccine in an adult over 50 years of age.

3.
Clin Infect Dis ; 2021 Nov 28.
Article in English | MEDLINE | ID: covidwho-2017777

ABSTRACT

BACKGROUND: Multisystem inflammatory syndrome in adults (MIS-A) was reported in association with the COVID-19 pandemic. MIS-A was included in the list of adverse events to be monitored as part of the emergency use authorizations issued for COVID-19 vaccines. METHODS: Reports of MIS-A patients received by the Centers for Disease Control and Prevention (CDC) after COVID-19 vaccines became available were assessed. Data collected on the patients included clinical and demographic characteristics and their vaccine status. The Vaccine Adverse Events Reporting System (VAERS) was also reviewed for possible cases of MIS-A. RESULTS: From December 14, 2020 to April 30, 2021, 20 patients who met the case definition for MIS-A were reported to CDC. Their median age was 35 years (range, 21-66 years), and 13 (65%) were male. Overall, 16 (80%) patients had a preceding COVID-19-like illness a median of 26 days (range 11-78 days) before MIS-A onset. All 20 patients had laboratory evidence of SARS-CoV-2 infection. Seven MIS-A patients (35%) received COVID-19 vaccine a median of 10 days (range, 6-45 days) before MIS-A onset; 3 patients received a second dose of COVID-19 vaccine 4, 17, and 22 days before MIS-A onset. Patients with MIS-A predominantly had gastrointestinal and cardiac manifestations and hypotension or shock. CONCLUSIONS: Although 7 patients were reported to have received COVID-19 vaccine, all had evidence of prior SARS-CoV-2 infection. Given the widespread use of COVID-19 vaccines, the lack of reporting of MIS-A associated with vaccination alone, without evidence of underlying SARS-CoV-2 infection, is reassuring.

4.
Intern Med ; 61(16): 2527-2532, 2022 Aug 15.
Article in English | MEDLINE | ID: covidwho-1993650

ABSTRACT

We herein report a case of multisystem inflammatory syndrome in adults (MIS-A) complicated with Kikuchi-Fujimoto disease (KFD). A previously healthy 41-year-old man presented with painful swelling of the cervical lymph nodes, fever, diarrhea, conjunctivitis, edema, and hypotension one month after the onset of asymptomatic coronavirus disease 2019. Laboratory investigations revealed an elevation of CRP, and echocardiography indicated diastolic dysfunction. We diagnosed the patient to have MIS-A. Histopathology of the lymph nodes showed necrotizing lymphadenitis. After the initiation of hydrocortisone and diuretics, his symptoms resolved immediately. This case suggested that post-viral immune dysregulation in MIS-A could play a role in the etiology of KFD.


Subject(s)
COVID-19 , Connective Tissue Diseases , Histiocytic Necrotizing Lymphadenitis , Adult , COVID-19/complications , Connective Tissue Diseases/complications , Histiocytic Necrotizing Lymphadenitis/complications , Histiocytic Necrotizing Lymphadenitis/diagnosis , Humans , Lymph Nodes/pathology , Male , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/diagnosis
5.
J Intensive Care Med ; : 8850666221121589, 2022 Aug 17.
Article in English | MEDLINE | ID: covidwho-1993238

ABSTRACT

The clinical spectrum of Coronavirus 2019 (COVID-19) includes acute COVID-19, long covid and multisystem inflammatory syndrome in children and adults (MISC/A). The rapid roll-out of COVID-19 vaccination has the potential to affect the clinical presentation of COVID-19 and case reports document rare occurrences of MIS-A after COVID-19 infection and recent vaccination with m-RNA vaccines. We describe 2 cases of MIS-A after COVID-19 infection and recent vaccination with ChAdOx1 nCoV-19.

6.
Cureus ; 14(4): e24438, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1954918

ABSTRACT

Introduction Classification criteria and practice guidelines for inpatient management of multisystem inflammatory syndrome (MIS) exist, but reports on outpatient management and clinical outcomes are lacking. Here we describe the management and clinical outcomes of four children and four adults with MIS seen at Walter Reed National Military Medical Center (WRNMMC) from diagnosis to six months follow-up. Methods This retrospective, case-series describes the initial presentation and management of MIS in four children and four adults seen at WRNMMC from March 2020 to September 2021. Data on each patient was collected from the time of exposure to the SARS-CoV-2 virus to six months post-diagnosis with MIS. Extracted data includes: demographics, comorbidities, initial MIS presentation, inpatient treatment, outpatient treatment, and clinical outcomes. Results A total of 62.5% of patients presented in shock. All pediatric patients received IVIG, methylprednisolone, and anakinra; no adult received this combination. Steroids and immunomodulatory medications were discontinued in 1-2 months outpatient. Three children and two adults had full symptomatic resolution. One child and two adults had persistent deconditioning at six months follow-up. One adult had persistent dyspnea. Conclusions MIS appears to be monophasic with no recurrences at six months follow-up in our patients who only required 1-2 months of glucocorticoid or immunomodulatory medications. The better outcomes in children raise the question of how much of this difference can be attributed to early combination therapy versus physiologic differences in children and adults.

7.
Clin Med (Lond) ; 22(3): 266-270, 2022 05.
Article in English | MEDLINE | ID: covidwho-1856279

ABSTRACT

Infection with SARS-CoV-2 may trigger a delayed hyper-inflammatory illness in children called paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS-TS). A similar syndrome is increasingly recognised in adults termed multisystem inflammatory syndrome in adults (MIS-A) and may present acutely to medical or surgical specialties with severe symptoms, such as acute abdominal pain or cardiogenic shock. No national guidelines exist in the UK for the management of MIS-A and there is limited evidence to guide treatment plans. We undertook a national Delphi process to elicit opinions from experts in hyperinflammation about the diagnosis and management of MIS-A with the dual aim of improving recognition and producing a management guideline. Colleagues in paediatrics successfully initiated a national consensus management document that facilitated regional multidisciplinary referral and follow-up pathways for children with PIMS-TS, and we propose a similar system be developed for adult patients across the UK. This would facilitate better recognition and treatment of MIS-A across the multiple specialties to which it may present as well as enable follow-up with specialty services post-discharge.


Subject(s)
COVID-19 , Aftercare , COVID-19/complications , COVID-19/therapy , Child , Humans , Patient Discharge , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/therapy , United Kingdom
8.
Cureus ; 14(4): e24042, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1847663

ABSTRACT

Multisystem inflammatory syndrome (MIS) after a primary infection with coronavirus disease 2019 (COVID-19) was first recognized in 2020 and presents with similar symptoms as Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome/secondary hemophagocytic lymphohistiocytosis. In children, it is called multisystem inflammatory syndrome in children (MIS-C); in adults, it is termed multisystem inflammatory syndrome in adults (MIS-A). This case offers a unique presentation of MIS in a 20-year-old young adult, who turned 21 years old one week after his presentation. He fits the criteria for MIS-C and MIS-A according to the Centers for Disease Control and World Health Organization, respectively. Initial symptoms in the emergency department included headache, neck stiffness, and fever with diffuse rash. Other symptoms consistent with MIS-C/A developed rapidly later during the course of the disease.

9.
Cureus ; 14(3): e23440, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1835781

ABSTRACT

COVID-19 is a respiratory illness with multiple extra-pulmonary complications. The multisystem inflammatory syndrome (MIS) is one of its complications that usually affects children and is known as MIS-C, but several cases have been reported in adults, symbolized by MIS-A. Thus, the Centers for Disease Control and Prevention (CDC) developed a working case definition of MIS-A, which includes several criteria. Here we report two cases of adult male patients with clinical and laboratory symptoms consistent with MIS-A. Case one patient presented at a late stage after two weeks post the onset of symptoms. His health deteriorated rapidly, and eventually, he passed away. However, the second patient presented a few days after the symptoms' onset and took a course of steroids. He was discharged home.

10.
Clin Infect Dis ; 2022 Apr 20.
Article in English | MEDLINE | ID: covidwho-1806307

ABSTRACT

BACKGROUND: Multisystem inflammatory syndrome in adults (MIS-A) is a severe condition temporally associated with SARS-CoV-2 infection. METHODS: In this retrospective cohort study, we applied the U.S. Centers for Disease Control and Prevention (CDC) case definition to identify diagnosed and undiagnosed MIS-A cases among adults discharged April 2020-January 2021 from four Atlanta, Georgia hospitals affiliated with a single medical center. Non-MIS-A COVID-19 hospitalizations were identified using International Classification of Diseases, Tenth Revision encounter code U07.1. We calculated the ratio of MIS-A to COVID-19 hospitalizations, compared demographic characteristics of the two cohorts, and described clinical characteristics of MIS-A patients. RESULTS: We identified 11 MIS-A cases, none of which were diagnosed by the treatment team, and 5,755 COVID-19 hospitalizations (ratio 1: 523). Compared with patients with COVID-19, patients with MIS-A were more likely to be younger than 50 years (72.7% vs. 26.1%, p < 0.01) and to be non-Hispanic Black persons (81.8% vs. 50.0%, p = 0.04). Ten patients with MIS-A (90.9%) had at least one underlying medical condition. Two MIS-A patients (18.2%) had a previous episode of laboratory-confirmed COVID-19, occurring 37 and 55 days prior to admission. All MIS-A patients developed left ventricular systolic dysfunction. None had documented mucocutaneous involvement. All required intensive care, all received systemic corticosteroids, eight (72.7%) required mechanical ventilation, two (18.2%) required mechanical cardiovascular circulatory support, and none received intravenous immunoglobulin. Two (18.2%) died or were discharged to hospice. CONCLUSIONS: MIS-A is severe but likely underrecognized complication of SARS-CoV-2 infection. Improved recognition of MIS-A is needed to quantify its burden and identify populations at highest risk.

11.
BMC Infect Dis ; 22(1): 300, 2022 Mar 28.
Article in English | MEDLINE | ID: covidwho-1765440

ABSTRACT

BACKGROUND: Severe inflammation and one or more extrapulmonary organ dysfunctions have been reported and this clinical picture is defined as "multisystem inflammatory syndrome in adults" (MIS-A) in severe coronavirus disease-2019 (COVID-19). We aimed to determine the effect of LDH/lymphocyte ratio (LLR) on the development of MIS-A. METHODS: The data of 2333 patients were retrospectively analyzed. RESULTS: MIS-A rate was found to be 9.9% and MIS-A related mortality was 35.3%. LRR level above 0.24 was found to predict MIS-A development with 70% sensitivity and 65.2% specificity. The risk of MIS-A development was found to be 3.64 times higher in those with LRR levels above 0.24 compared to those with 0.24 and below. In patients with MIS-A, LRR level above 0.32 predicts mortality with 78% sensitivity and 70% specificity. CONCLUSIONS: Early detection of MIS-A with high sensitivity and specificity in a practical ratio is very important in terms new studies.


Subject(s)
COVID-19 , Malnutrition , Adult , Humans , Inflammation/diagnosis , Malnutrition/diagnosis , Retrospective Studies , Systemic Inflammatory Response Syndrome
12.
Emerg Infect Dis ; 28(5): 1017-1020, 2022 05.
Article in English | MEDLINE | ID: covidwho-1760188

ABSTRACT

We observed multisystem inflammatory syndrome in 2 older adults in the United States who had received mRNA coronavirus disease vaccine soon after natural infection. We identified 5 similar cases from the Vaccine Adverse Events Reporting System. The timing of vaccination soon after natural infection might have an adverse effect on the occurrence of vaccine-related systemic inflammatory disorders.


Subject(s)
COVID-19 , Drug-Related Side Effects and Adverse Reactions , Aged , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , SARS-CoV-2 , United States , Vaccination/adverse effects
13.
Cureus ; 14(2): e22640, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1726761

ABSTRACT

Multisystem inflammatory syndrome (MIS) in adults associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is increasingly reported in published literature, although published reports remain sparse. In this report, we describe our first experience with a 31-year-old Caucasian male who developed severe MIS 31 days after a mild SARS-CoV-2 infection. The patient developed fever, elevated C-reactive protein (CRP), procalcitonin (PCT), reduced ejection fraction (EF), and shock. After extensive diagnostic work-up, nothing was found to justify his shock manifestation. A similar treatment to MIS in children (MIS-C) with immunoglobulins, corticosteroids, and anticoagulants led to a remarkable clinical improvement. MIS in adults (MIS-A) can be fatal. The early identification of MIS plays a crucial role in the prompt initiation of suitable treatment. Therefore, differential diagnosis and exclusion of other causes of illness are of priority. We believe that MIS in children treatment guidelines can be reformed in a way to include MIS in adults as well.

14.
Cureus ; 14(2): e22123, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1726759

ABSTRACT

Hyperinflammatory syndrome with breakthrough coronavirus disease 2019 (COVID-19) infection in a fully vaccinated patient is not a common finding. To the best of our knowledge, this is the first such case of a patient who received the Spikevax/Moderna (elasomeran mRNA-1273) vaccine. The patient exhibited clinical characteristics consistent with both multisystem inflammatory syndrome in adults (MIS-A) and hemophagocytic lymphohistiocytosis (HLH), thus posing a diagnostic challenge. Multi-inflammatory syndrome in COVID-19 patients is frequently seen in the pediatric population, but it is a rare entity in adults especially after receiving COVID-19 vaccination. The pathophysiology of MIS-A is not completely understood yet, but it is believed that this likely occurs due to antibody-mediated immune dysregulation. There is a possibility of enhanced serologic response in patients like ours who are vaccinated and have breakthrough COVID-19 infection, thus paving the way for overwhelming antibody-mediated immune activation. There is a significant overlap between symptoms of MIS-A and other hyperinflammatory syndromes such as HLH; hence, a high degree of clinical suspicion and thorough diagnostic workup is required to explore all differentials. Our case raises concerns regarding the lack of clear algorithms and guidelines to diagnose and manage MIS-A in adults post-COVID-19 vaccination.

15.
Cureus ; 14(2): e22103, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1726756

ABSTRACT

Multisystem inflammatory syndrome in adults (MIS-A) is an extremely rare para-infectious or post-infectious complication of coronavirus disease 2019 (COVID-19) that requires prompt recognition and early treatment to avert severe morbidity and mortality. A 55-year-old woman presented to us with fever, multiple ischemic strokes, thrombocytopenia, elevated inflammatory markers, and multiorgan dysfunction a few days after COVID-19 illness. She was severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-negative at admission. MRI showed multiple posterior circulation infarctions. She required intensive treatment with intravenous methylprednisolone (IVMP), intravenous immunoglobulin (IVIg), sustained low-efficiency dialysis (SLED), and plasmapheresis for disease remission. Initially, her presentation raised concern for thrombotic thrombocytopenic purpura, however, many features raised the suspicion of a multisystem inflammatory syndrome in adults (MIS-A). Our patient had increased levels of D-dimer, fibrinogen, interleukin 6 (IL-6), and large artery thromboembolism, A positive direct Coomb's test was also more suggestive of immune-mediated hemolysis rather than traction hemolysis, which is the pathophysiology of hemolytic anemia in TTP. Furthermore, MIS-A is known to present with gastrointestinal (GI) symptoms, whereas our case reports predominantly neurological symptoms with relative GI sparing. The overall inflammatory milieu secondary to MIS-A would have contributed to the formation of immune thrombosis, which would have embolized up the vertebrobasilar tree. The MR angiogram did not show any atherosclerotic changes, ruling out an atherosclerotic etiology, which is quite common in posterior circulation infarctions. Multiple courses of immunomodulatory treatment and prolonged treatment with steroids led to disease stabilization.

16.
Am Heart J Plus ; 13: 100113, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1719160

ABSTRACT

The introduction of coronavirus 2019 (COVID-19) vaccination has been an integral force in stopping the spread of COVID-19 across the globe. While reported side effects of vaccination have predominantly been mild, in the last year reports have emerged of myocarditis following the BNT162b2 (Pfizer-BioNtech) and mRNA-1273 (Moderna) vaccinations. The adolescent and young adult population have been the population most reported, with over 1000 cases under review by the Centers for Disease Control (CDC) since April 2021. Here we report a case of a previously healthy 21-year-old male who developed Multisystem Inflammatory Syndrome in Adults (MIS-A) and following the second dose of the Pfizer-BioNtech vaccine. The young male initially presented with fever, leukocytosis with high neutrophil-lymphocyte ratio, severe cardiac illness, and positive COVID-19 nucleocapsid serology, consistent with MIS-A diagnosis. His case was complicated by cardiogenic shock, requiring brief venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. While this report does not detract from the overwhelming benefit of vaccination from COVID-19, clinicians should be aware of this possible relationship in the future.

17.
Eur Heart J Case Rep ; 6(1): ytab521, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1713650

ABSTRACT

BACKGROUND: Multisystem inflammatory syndrome in adults (MIS-A) is a rare but potentially life-threatening condition that may occur during or in the weeks following severe acute respiratory syndrome coronavirus-2 infection. To date, only case reports and small case series have described typical findings and management of patients with MIS-A. The prevalence of MIS-A is largely unknown due to the lack of data. CASE SUMMARY: A 30-year-old male patient presented to the emergency department with new-onset of fever, chest discomfort, macular exanthema, abdominal pain, mild dyspnoea, and coughing. The patient reported a mildly symptomatic recent coronavirus disease-19 (COVID-19). Significantly increased markers of inflammation and a modest increase of cardiac troponin were found upon laboratory work-up at admission. Despite broad-spectrum antibiotics, the patient's clinical status deteriorated continuously. Cardiac work-up, including echocardiography, coronary angiography, and cardiac magnetic resonance imaging, was done and signs of acute myocarditis with mildly reduced left ventricular systolic function were found. The complex multi-organ symptom constellation facilitated the diagnosis of MIS-A following COVID-19 infection. Besides aspirin, intravenous, continuous hydrocortisone treatment was initiated, resulting in a prompt improvement of symptoms and clinical findings. DISCUSSION: We report a case of successfully treated MIS-A in the context of COVID-19, which further adds to the existing literature on this rare but clinically significant condition. Our case highlights the necessity of an interdisciplinary approach to correctly diagnose this complex, multi-organ disease and enable fast and appropriate management of these high-risk patients.

18.
Acute Med Surg ; 9(1): e737, 2022.
Article in English | MEDLINE | ID: covidwho-1702936

ABSTRACT

BACKGROUND: Multisystem inflammatory syndrome in adults (MIS-A) is a postacute coronavirus disease 2019 (COVID-19) syndrome occurring weeks after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although this hyperinflammatory syndrome causes significant morbidity, mortality is low. Reports of MIS-A following acute respiratory distress syndrome (ARDS) due to SARS-CoV-2 infection have rarely been reported. We describe two cases of MIS-A that developed after recovery from critical acute COVID-19. CASE PRESENTATION: We present two cases of MIS-A. In both cases, approximately 4 weeks after the onset of COVID-19, the patients developed gastrointestinal disorders, complicated by other organ damage, and died. CONCLUSION: ARDS and MIS-A can occur in a patient with COVID-19 at different times of onset. Clinicians should consider MIS-A when unexplained multisystemic abnormalities are noted after the treatment of ARDS due to COVID-19.

19.
Epidemiol Infect ; 150: e26, 2022 01 17.
Article in English | MEDLINE | ID: covidwho-1683880

ABSTRACT

Multisystem inflammatory syndrome in adults (MIS-A) is a hyperinflammatory illness related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The characteristics of patients with this syndrome and the frequency with which it occurs among patients hospitalised after SARS-CoV-2 infection are unclear. Using the Centers for Disease Control and Prevention case definition for MIS-A, we created ICD-10-CM code and laboratory criteria to identify potential MIS-A patients in the Premier Healthcare Database Special COVID-19 Release, a database containing patient-level information on hospital discharges across the United States. Modified MIS-A criteria were applied to hospitalisations with discharge from March to December 2020. The proportion of hospitalisations meeting electronic health record criteria for MIS-A and descriptive statistics for patients in the potential MIS-A cohort were calculated. Of 34 515 SARS-CoV-2-related hospitalisations with complete clinical and laboratory data, 53 met modified criteria for MIS-A (0.15%). The median age was 62 years (IQR 52-74). Most patients met the severe cardiac illness criterion through either myocarditis (66.0%) or new-onset heart failure (35.8%). A total of 79.2% of patients required ICU admission, while 43.4% of patients in the cohort died. MIS-A appears to be a rare but severe outcome of SARS-CoV-2 infection. Additional studies are needed to investigate how this syndrome differs from severe coronavirus disease 2019 (COVID-19) in adults.


Subject(s)
COVID-19/complications , Systemic Inflammatory Response Syndrome/diagnosis , Aged , COVID-19/diagnosis , COVID-19/ethnology , COVID-19/mortality , Cohort Studies , Databases, Factual , Female , Humans , Intensive Care Units , Male , Middle Aged , Systemic Inflammatory Response Syndrome/ethnology , Systemic Inflammatory Response Syndrome/mortality
20.
Indian J Crit Care Med ; 26(1): 145-148, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1675042

ABSTRACT

How to cite this article: Arjun R, Niyas VKM, Thomas SM, Raman M, Thomas A, Aloysius W, et al. Multisystem Inflammatory Syndrome in Adults and Adolescents Associated with COVID-19 Infection: A Single-center Experience. Indian J Crit Care Med 2022;26(1):145-148.

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