Post COVID-19 Infection Multisystem Inflammatory Syndrome in Adults Presenting with Pain, Ascending Weakness, and Paresthesias: A Case Report

ABSTRACT

Case Diagnosis Post COVID-19 infection multisystem inflammatory syndrome in adults presenting in a 28-year-old African American female with pain, ascending weakness, paresthesias, and chest pain. Case Description or Program Description Patient with documented COVID-19 infection 5 weeks prior to arrival and presented with pain, paresthesias, and weakness in the bilateral lower extremities. Symptoms began shortly after patient recovered from COVID-19 infection, however, patient developed ascending weakness extending into the hands with left sided chest pain, prompting patient to present for evaluation. Setting(s) Major academic and referral center with level 1 adult trauma. Assessment/Results: Lumbar puncture and cerebrospinal fluid studies were not suggestive of Guillain- Barre syndrome. Imaging of the entire neuraxis was unremarkable. Echocardiogram revealed new onset heart failure with reduced ejection fraction of 35% consistent with non-ischemic cardiomyopathy and cardiac imaging was not suggestive of amyloidosis. EMG was consistent with primarily axonal greater than motor peripheral polyneuropathy. Further inflammatory workup revealed elevated erythrocyte sedimentation rate and C reactive protein. Paraneoplastic workup was unremarkable. Patient was started on intravenous immunoglobulin (IVIG) for suspected Multisystem Inflammatory Syndrome in Adults (MIS-A), however, patient developed infusion reaction shortly after infusion began and IVIG was discontinued pending hemodynamic stability. Discussion (relevance) Post COVID-19 multisystem inflammatory syndrome is seen more commonly in children than in adults per literature review. Clinicians must be mindful of potential MIS-A in adult patients with symptoms mimicking Guillain-Barre syndrome with negative workup and imaging, especially with concomitant cardiovascular compromise and elevated inflammatory markers. This case demonstrates one of the various presentations documented of MIS-A and is important for accurate diagnosis of this syndrome in the future. Conclusion(s) Post COVID-19 patients presenting with symptoms similar to Guillain-Barre syndrome with negative workup should be evaluated for MIS-A as this syndrome can affect multiple organ systems simultaneously, such as the nervous system and cardiovascular system as seen in this patient.