Hidden Danger of Sars-Cov-2, Multisystem Inflammatory Syndrome in Adults (Mis-a): First Case Series in a Single Center from Turkiye

ABSTRACT

Objective: Multisystem Inflammatory Syndrome (MIS) is a con-dition seen in the early post-COVID-19 period and thought to develop with an impaired immune response. It has been usually reported in children but rarely in adults. Here we report the first MIS-A case series from Turkiye.Material and Methods: Six patients who met the Centers for Disease Control and Preventions MIS-A diagnostic criteria were included in the study. The demographic, clinical, laboratory, ra-diological characteristics and therapy regimes and outcomes of the patients were recorded.Results: All of our cases had a history of mild COVID-19. They presented with fever, severe fatigue and hypotension. Abnormal echocardiography findings were detected in five patients. Only one patient had multiple mucocutaneous findings. Common lab-oratory features were lymphopenia, markedly increased C-Reak-tive Protein, procalcitonin, pro-brain natriuretic peptide (pro-BNP), D-dimer, and ferritin. All patients had positive SARS-CoV-2 antibody result. Corticosteroids and/or anakinra were used in five, Intravenous immunoglobulin was used in two patients. Low-mo-lecular-weight heparin (LMWH) was used for all cases. Empirically initiated antibiotic treatments were discontinued after cultures were negative. After anti-inflammatory treatment, the hypoten-sion of the patients resolved, they did not need intensive care follow-up and no mortality was seen in our cases.Conclusions: MIS-A is a severe and mortal condition that causes various clinical pictures and can be confused with sepsis. Anakin-ra, a recombinant IL-1 receptor antagonist, is a significant agent that can be used in the treatment of MIS-A since it blocks the cytokine cascade at an early stage. The satisfactory respons-es will be obtained with early diagnosis and anti-inflammatory treatment. In this period when the pandemic is not over yet, it is necessary to increase the awareness of clinicians about MIS-A, which can be fatal.