MISLEADING FEVERS: A CASE OF MULTISYSTEM INFLAMMATORY SYNDROME IN ADULTS DUE TO COVID-19

ABSTRACT

SESSION TITLE Management of COVID-19-Induced Complications SESSION TYPE Rapid Fire Case Reports PRESENTED ON 10/19/2022 1245 pm - 145 pm INTRODUCTION: Multisystem inflammatory syndrome in children (MIS-C) is a systemic condition that causes multi-organ dysfunction accompanied by fever and extremely elevated inflammatory markers. This syndrome been primarily identified in children or adolescents similar to Kawasaki disease. The hallmark of this illness includes life-threatening complications such as shock and cardiac dysfunction. As the cases of COVID-19 continue to increase worldwide, a form of MIS-C can present in adults known as multisystem inflammatory syndrome in adults (MIS-A). We describe a case of MIS-A after exposure to COVID-19. CASE PRESENTATION A 28-year-old Hispanic male with no medical history presented with 3 days of persistent fever, diarrhea, and fatigue. He was unvaccinated for COVID-19 but had mild disease three months prior, which did not require hospitalization. Vitals were remarkable for tachycardia and constant fever of up to 103.5 F. Labs were notable for leukocytosis of 26.0 k/uL, CRP of 43 mg/dL, and procalcitonin of 90 ng/mL. Computed tomography with intravenous contrast of his chest revealed multifocal nodular and consolidative airspace disease of the right upper and middle lobes with mediastinal and hilar lymphadenopathy. Echocardiogram revealed ejection fraction (EF) of 29% without wall-motion abnormalities. PCR test for COVID-19 was negative and his infectious work-up was unrevealing. His course was further complicated by shock requiring pressors, intubation, and renal replacement therapy. Despite antibiotics, he did not improve. He was started on pulse dose steroids and intravenous immunoglobulin (IVIG), which decreased his CRP to 34 mg/dL and procalcitonin to 51 ng/mL. He was weaned off the ventilator and pressor support with EF recovery to 51%. He was eventually discharged home without further needs. DISCUSSION: While limited data exists, adult patients of all ages with prior SARS-CoV-2 infection can develop MIS-A. Preliminary reports suggest increased incidence among African American, Hispanic, and Asian ethnic groups. Diagnosis includes one primary and two secondary clinical criteria with two supporting laboratory evidence. Primary criteria includes cardiac dysfunction or rash with conjunctivitis. Secondary criteria includes neurological signs, shock, gastrointestinal disease, or thrombocytopenia. Lab markers include elevated CRP, ferritin, IL-6, ESR, or procalcitonin with a positive SARS-Cov-2 PCR, serology, or antigen detection. Treatment consists of steroids, IVIG, and supportive care based on case reports. There are no current evidence-based guidelines. The best preventative measures include COVID-19 vaccination CONCLUSIONS: MIS-A is a rare complication of unvaccinated COVID-19 cases. Diagnostic criteria include one primary and two secondary clinical signs with supporting lab data. Treatment includes steroids, IVIG, and supportive care. Reference #1 Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. The Lancet. 2020;395(10237)1607-1608. doi10.1016/s0140-6736(20)31094-1 Reference #2 Kunal S, Ish P, Sakthivel P, Malhotra N, Gupta K. The emerging threat of multisystem inflammatory syndrome in adults (mis-A) in COVID-19 A systematic review. Heart & Lung. 2022;547-18. doi10.1016/j.hrtlng.2022.03.007 Reference #3 Morris SB, Schwartz NG, Patel P, et al. Case series of multisystem inflammatory syndrome in adults associated with SARS-COV-2 infection — United Kingdom and United States, March–August 2020. MMWR Morbidity and Mortality Weekly Report. 2020;69(40)1450-1456. doi10.15585/mmwr.mm6940e1 DISCLOSURES No relevant relationships by Sadaf Afraz No relevant relationships by Christine Girard No relevant relationships by Jose Rivera No relevant relationships by Ivan Romero-Legro No relevant relationships by Amy Van