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Michailides C, Papantoniou K, Paraskevas T, Lagadinou M, Marangos M, Kavvousanos M, Michailidou P, Velissaris D. Multisystem Inflammatory Syndrome of the Adults (MIS-A) - The undercover threat for young adults. A systematic review and meta-analysis of medical cases. LE INFEZIONI IN MEDICINA 2024; 32:272-279. [PMID: 39282538 PMCID: PMC11392540 DOI: 10.53854/liim-3203-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/30/2024] [Indexed: 09/19/2024]
Abstract
Background COVID-19 related syndromes are not yet well described and understood. Multisystem inflammatory syndrome of the adults (MIS-A) is a recently characterized syndrome affecting multiple organs of young adults, causing serious complications, even shock and death. Objectives To determine the clinical characteristics, course, and complications of MIS-A in a systematic way and summarize currently used treatments. Methods Literature search in March 2023 in PubMed and Scopus databases. Case reports and case-series that fulfilled the CDC criteria for MIS-A were eligible for inclusion. Results A total of 71 patients from 60 reports were included. 66% of the patients were male and the mean age of the synthetic cohort was 32.9 years old. The majority (70.4%) of the enrolled cases had no significant medical history. MIS-A was diagnosed after a median of 4 weeks period. All but two patients presented with cardiac symptoms, while the most common secondary diagnostic criterion was abdominal pain, vomiting or diarrhea followed by shock or hypotension. Heart failure therapy and immunomodulation were used as therapeutic options. Although more than half of the cohort was admitted to the Intensive Care Unit (ICU) (n=39) only 4 deaths were reported. Conclusion MIS-A can affect patients independently of age, sex, and co-morbidity status, resulting in serious complications, often including severe cardiac disease, shock, acute kidney injury and sometimes death. It can occur immediately after SARS-CoV-2 acute infection until two months later, usually manifesting four weeks after acute disease.
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Affiliation(s)
| | | | | | - Maria Lagadinou
- Department of Internal Medicine, Patras University Hospital, Patras, Greece
| | - Markos Marangos
- Department of Internal Medicine, Patras University Hospital, Patras, Greece
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Chen CJ, Kao HY, Huang CH, Li CJ, Hung CH, Yong SB. New insight into the intravenous immunoglobulin treatment in Multisystem Inflammatory Syndrome in children and adults. Ital J Pediatr 2024; 50:18. [PMID: 38273368 PMCID: PMC10809493 DOI: 10.1186/s13052-024-01585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/07/2024] [Indexed: 01/27/2024] Open
Abstract
Within 6 months of the coronavirus pandemic, a new disease entity associated with a multisystem hyperinflammation syndrome as a result of a previous infection with the SARS-CoV-2 virus is increasingly being identified in children termed Multisystem Inflammatory Syndrome in Children (MIS-C) and more recently in adults(MIS-A). Due to its clinical similarity with Kawasaki Disease, some institutions have used intravenous immunoglobulins and steroids as first line agents in the management of the disease. We seek to find how effective intravenous immunoglobulin therapy is across these two disease entities. A comprehensive English literature search was conducted across PubMed, MEDLINE, and EMBASE databases using the keywords multisystem inflammatory syndrome in children/adults and treatment. All major online libraries concerning the diagnosis and treatment of MIS-C and MIS-A were searched. Relevant papers were read, reviewed, and analyzed. The use of intravenous immunoglobulins (IVIG) and steroids for the treatment of multisystemic inflammatory syndrome in children(MIS-C) is well established and recommended by multiple pediatric governing institutions. However, there is still no optimal treatment guideline or consensus on the use of IVIG in adults. The use of IVIG in both the child and adult populations may lower the risk of treatment failure and the need for adjunctive immunomodulatory therapy. Despite the promising results of IVIG use for the management of MIS-C and MIS-A, considering the pathophysiological differences between MIS-C and MIS-A, healthcare professionals need to further assess the differences in disease risk and treatment. The optimal dose, frequency, and duration of treatment are still unknown, more research is needed to establish treatment guidelines.
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Affiliation(s)
- Chih-Jen Chen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsu-Yen Kao
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ching-Hua Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chia-Jung Li
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, 813, Kaohsiung, Taiwan
- Institute of Biopharmaceutical Sciences, National Sun Yat-sen University, 804, Kaohsiung, Taiwan
| | - Cheng-Hsien Hung
- Department of Pharmacy, Chang Bing Show Chwan Memorial Hospital, 50544, No.6, Lugong Rd., Lukang Township, Changhua, Taiwan.
| | - Su-Boon Yong
- Department of Allergy and Immunology, China Medical University Children's Hospital, No. 2, Yuh‑Der Road, 404, Taichung City, Taiwan.
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Asano S, Shibata T, Tsunoda Y, Ishii A, Kayukawa T, Kobayashi M, Orinaka M, Miyamatsu S, Ryuge Y, Kato K. Multisystem Inflammatory Syndrome in an Adult on Hemodialysis with Markedly Elevated Procalcitonin and Ferritin Levels. Intern Med 2023; 62:2571-2575. [PMID: 37344434 PMCID: PMC10518544 DOI: 10.2169/internalmedicine.1832-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/14/2023] [Indexed: 06/23/2023] Open
Abstract
A 21-year-old man on hemodialysis was hospitalized for coronavirus disease 2019 (COVID-19) pneumonia. After admission, he had a persistent high fever and developed erythema induratum on his extremities. Laboratory tests conducted 25 days after onset showed markedly increased procalcitonin (PCT) levels (>100 ng/mL). The patient developed impaired consciousness and hypotensive shock and required endotracheal intubation. Based on the presence of erythema induratum and multiorgan dysfunction, he was diagnosed with multisystem inflammatory syndrome (MIS). The MIS resolved after treatment with intravenous immunoglobulin and methylprednisolone. This report illustrates that MIS can occur in adults and may be accompanied by high PCT levels.
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Affiliation(s)
- Shuichi Asano
- Department of Respirology, Japan Community Health Care Organization Chukyo Hospital, Japan
| | - Tomofumi Shibata
- Department of Respirology, Japan Community Health Care Organization Chukyo Hospital, Japan
| | - Yohei Tsunoda
- Department of Respirology, Japan Community Health Care Organization Chukyo Hospital, Japan
| | - Azusa Ishii
- Department of Respirology, Japan Community Health Care Organization Chukyo Hospital, Japan
| | - Takafumi Kayukawa
- Department of Respirology, Japan Community Health Care Organization Chukyo Hospital, Japan
| | - Masahiro Kobayashi
- Department of Respirology, Japan Community Health Care Organization Chukyo Hospital, Japan
| | - Masami Orinaka
- Department of Respirology, Japan Community Health Care Organization Chukyo Hospital, Japan
| | - Shoko Miyamatsu
- Department of Respirology, Japan Community Health Care Organization Chukyo Hospital, Japan
| | - Yoshio Ryuge
- Department of Respirology, Japan Community Health Care Organization Chukyo Hospital, Japan
| | - Kimihiro Kato
- Department of Nephrology, Japan Community Health Care Organization Chukyo Hospital, Japan
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Qamar MA, Afzal SS, Dhillon RA, Sajid MI, Sarfraz Z, Sarfraz A, Narmeen M, Irfan O, Cherrez-Ojeda I, Bin Sarwar Zubairi A. A global systematic review and meta-analysis on the emerging evidence on risk factors, clinical characteristics, and prognosis of multisystem inflammatory syndrome in adults (MIS-A). Ann Med Surg (Lond) 2023; 85:4463-4475. [PMID: 37663717 PMCID: PMC10473365 DOI: 10.1097/ms9.0000000000000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 04/18/2023] [Indexed: 09/05/2023] Open
Abstract
Background The multisystem inflammatory syndrome in adults (MIS-A) has emerged, similar to those in children associated with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) [multisystem inflammatory syndrome in children (MIS-C)]. This review aimed to analyze the risk factors, clinical course, and prognosis of MIS-A. Methods A comprehensive literature search was conducted using several databases for cases reporting MIS-A from 1 December 2019 till 9 September 2021. The case definitions used to identify potential cases were those recommended by the World Health Organization, Center for Disease Control, and individual country/physician classification. The meta-analysis was performed using Comprehensive Meta-Analysis (CMA) 2.2.027 and Review Manager (RevMan) 5.4.1, employing 95% confidence intervals (CI). Results Seventy studies were assessed for full-text eligibility, out of which 37 were included. The mean age of the study population was 32.52±10.29 years. The most common symptoms were fever (89.8%, 95% CI: 77.7-95.7%) and diarrhea (49%, 95% CI: 35.4-62.7%). Ventricular tachycardia (57.1%, 95% CI: 43.1-70.1%) was the most common electro-cardiac abnormality. The most common inflammatory marker was elevated C-reactive protein (89.8%, 95% CI: 77.7-95.7%). Abnormal echocardiogram was the most common imaging test result (commonly, ventricular dysfunction and arrhythmias), while steroids were the most administered treatment. Severe cases had a higher need for vasopressor and inotropic support and antibiotic therapy compared to the non-severe cases. One death was reported due to cardiovascular failure. Conclusion Our collated findings will help clinicians identify the typical presenting symptoms and optimal management of MIS-A. Further research is required to understand the long-term prognosis and the correlation between coronavirus disease 2019 (COVID-19) and MIS-A to understand its pathogenesis and clinical spectrum.
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Affiliation(s)
| | | | | | - Mir Ibrahim Sajid
- Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, Florida, USA
| | - Zouina Sarfraz
- Research and Publications, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Azza Sarfraz
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Mehek Narmeen
- Dr. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan
| | - Omar Irfan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Ivan Cherrez-Ojeda
- Allergy, Immunology and Pulmonology, Universidad Espíritu Santo, Samborondón, Ecuador
| | - Ali Bin Sarwar Zubairi
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Cobat A, Zhang Q, Abel L, Casanova JL, Fellay J. Human Genomics of COVID-19 Pneumonia: Contributions of Rare and Common Variants. Annu Rev Biomed Data Sci 2023; 6:465-486. [PMID: 37196358 PMCID: PMC10879986 DOI: 10.1146/annurev-biodatasci-020222-021705] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection is silent or benign in most infected individuals, but causes hypoxemic COVID-19 pneumonia in about 10% of cases. We review studies of the human genetics of life-threatening COVID-19 pneumonia, focusing on both rare and common variants. Large-scale genome-wide association studies have identified more than 20 common loci robustly associated with COVID-19 pneumonia with modest effect sizes, some implicating genes expressed in the lungs or leukocytes. The most robust association, on chromosome 3, concerns a haplotype inherited from Neanderthals. Sequencing studies focusing on rare variants with a strong effect have been particularly successful, identifying inborn errors of type I interferon (IFN) immunity in 1-5% of unvaccinated patients with critical pneumonia, and their autoimmune phenocopy, autoantibodies against type I IFN, in another 15-20% of cases. Our growing understanding of the impact of human genetic variation on immunity to SARS-CoV-2 is enabling health systems to improve protection for individuals and populations.
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Affiliation(s)
- Aurélie Cobat
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France;
- Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA;
| | - Qian Zhang
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France;
- Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA;
| | - Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France;
- Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA;
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France;
- Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA;
- Howard Hughes Medical Institute, New York, NY, USA
- Department of Pediatrics, Necker Hospital for Sick Children, Paris, France
| | - Jacques Fellay
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland;
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Precision Medicine Unit, Biomedical Data Science Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Kashfi S, Pierce M. Multisystem Inflammatory Syndrome Causing Mixed Cardiogenic Shock in a 34-Year-Old With Influenza A. Cureus 2023; 15:e36417. [PMID: 37090278 PMCID: PMC10115191 DOI: 10.7759/cureus.36417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/22/2023] Open
Abstract
Multisystem inflammatory syndrome in adults (MIS-A) is a sequela of COVID-19 and can cause mixed cardiogenic and vasodilatory shock. We present the case of a 34-year-old female who presented with mixed cardiogenic and vasodilatory shock and was found to be influenza A positive while also meeting criteria for MIS-A. She responded well to treatment with steroids and intravenous immunoglobulin (IVIG).
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Affiliation(s)
- Simon Kashfi
- Internal Medicine, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, USA
| | - Matthew Pierce
- Cardiology, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, USA
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7
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Ck A, C A, Nedunchezian B, Srinivasan S, Augustine AT. Multisystem Inflammatory Syndrome in Adults Associated With COVID-19: A Case Series on the Importance of Early Diagnosis and Corticosteroid Therapy in Prognosis. Cureus 2023; 15:e36068. [PMID: 36923015 PMCID: PMC10010151 DOI: 10.7759/cureus.36068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Multisystem inflammatory syndrome in adults (MIS-A) is a rare condition that can occur after an adult has been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It can occur anywhere between two and 12 weeks after the beginning of acute coronavirus disease 2019 (COVID-19) infection and is characterized by extrapulmonary multiorgan failure. It is primarily seen in young and previously healthy individuals. The exact prevalence of MIS-A is unclear. It is likely underdiagnosed due to overlapping symptoms with severe COVID-19 and difficulty in identifying the syndrome without a preceding COVID-19 infection. The pathogenesis of MIS-A is also largely unknown but is likely caused by an immune response that is dysregulated or antibody-mediated. Treatment primarily involves corticosteroids, but severe cases may require intravenous immune globulin (IVIG). The timing of starting corticosteroid therapy is crucial, as delays can result in increased complications and a longer hospital stay.
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Affiliation(s)
- Anees Ck
- Department of General Medicine, Dr. Moopen's Medical College, Wayanad, IND
| | - Arjun C
- Department of General Medicine, Dr. Moopen's Medical College, Wayanad, IND
| | | | - Shuba Srinivasan
- Department of General Medicine, Sri Madhusudan Sai Institute of Medical Sciences and Research, Chikkaballapur, IND
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8
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Lai CC, Hsu CK, Hsueh SC, Yen MY, Ko WC, Hsueh PR. Multisystem inflammatory syndrome in adults: Characteristics, treatment, and outcomes. J Med Virol 2023; 95:e28426. [PMID: 36571257 DOI: 10.1002/jmv.28426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/26/2022] [Accepted: 11/18/2022] [Indexed: 12/27/2022]
Abstract
Following the rapidly increasing number of multisystem inflammatory syndromes in children (MIS-C), a similar clinical scenario has been observed in adult patients. Although its prevalence is low and probably related to underdiagnosis, its development can be associated with high mortality. Multisystem inflammatory syndrome in adults (MIS-A) can develop following both asymptomatic and symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and in previously healthy people. Like MIS-C, MIS-A is a multisystem disease that can involve the cardiovascular, respiratory, gastrointestinal, dermatologic, hematologic, and neurologic systems. In addition to the clinical manifestations, the diagnosis of MIS-A requires laboratory evidence of inflammation and SARS-CoV-2 infection. The appropriate treatment for MIS-A remains unclear; anti-inflammatory agents, including intravenous immunoglobulin and corticosteroids, are commonly used. However, there are still many unknowns regarding MIS-A. Further studies are needed to determine the true prevalence, pathogenesis, and effective treatment for MIS-A.
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Affiliation(s)
- Chih-Cheng Lai
- Department of Internal Medicine, Division of Hospital Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chi-Kuei Hsu
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Shun-Chung Hsueh
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Muh-Yong Yen
- Division of Infectious Diseases, Cheng Hsin General Hospital, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Ren Hsueh
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan.,Departments of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Vásconez-González J, Izquierdo-Condoy JS, Fernandez-Naranjo R, Ortiz-Prado E. A Systematic Review and Quality Evaluation of Studies on Long-Term Sequelae of COVID-19. Healthcare (Basel) 2022; 10:2364. [PMID: 36553888 PMCID: PMC9778202 DOI: 10.3390/healthcare10122364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/08/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022] Open
Abstract
COVID-19 made its debut as a pandemic in 2020; since then, more than 607 million cases and at least 6.5 million deaths have been reported worldwide. While the burden of disease has been described, the long-term effects or chronic sequelae are still being clarified. The aim of this study was to present an overview of the information available on the sequelae of COVID-19 in people who have suffered from the infection. A systematic review was carried out in which cohort studies, case series, and clinical case reports were included, and the PubMed, Scielo, SCOPUS, and Web of Science databases were extracted. Information was published from 2020 to 1 June 2022, and we included 26 manuscripts: 9 for pulmonary, 6 for cardiac, 2 for renal, 8 for neurological and psychiatric, and 6 for cutaneous sequelae. Studies showed that the most common sequelae were those linked to the lungs, followed by skin, cutaneous, and psychiatric alterations. Women reported a higher incidence of the sequelae, as well as those with comorbidities and more severe COVID-19 history. The COVID-19 pandemic has not only caused death and disease since its appearance, but it has also sickened millions of people around the globe who potentially suffer from serious illnesses that will continue to add to the list of health problems, and further burden healthcare systems around the world.
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Affiliation(s)
- Jorge Vásconez-González
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito 170507, Ecuador
| | - Juan S. Izquierdo-Condoy
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito 170507, Ecuador
- Health Management and Research Area, Universidad Internacional Iberoamericana, Arecibo, PR 00613, USA
| | - Raul Fernandez-Naranjo
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito 170507, Ecuador
| | - Esteban Ortiz-Prado
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Quito 170507, Ecuador
- Facultad de Ciencias de la Salud, Universidad Latina de Costa Rica, San José 11501, Costa Rica
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Sreckovic M, Marjanovic RR, Jovicic BP, Jankovic S, Medovic R, Cvetkovic MB, Lazarevic T, Milosavljevic M, Simovic S, Vucic R. Multisystem inflammatory syndrome in a young adult successfully treated with plasmapheresis, immunoglobulins, and corticosteroids: a case report. Int J Infect Dis 2022; 122:1052-1055. [PMID: 35908721 PMCID: PMC9331018 DOI: 10.1016/j.ijid.2022.07.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/16/2022] [Accepted: 07/22/2022] [Indexed: 01/25/2023] Open
Abstract
A novel condition named multisystem inflammatory syndrome has raised the alarm worldwide and is leading to severe illness and long-term effects in the post-COVID era. This condition includes infection with fever, abdominal symptoms, acute cardiac injury, and shock. It has similarities with severe forms of Kawasaki disease (KD). In this study, we present a case of a 20-year-old male patient with multisystem inflammatory syndrome associated with COVID-19 infection who was successfully treated with plasmapheresis, immunoglobulins, and steroids for 4 h/day without heparinization or ultrafiltration. Plasmapheresis represents a therapeutic option for KD in patients with all other therapeutic strategies that have failed. However, there is no evidence from controlled clinical trials confirming this option. In our case, plasmapheresis was beneficial in stabilizing and improving the patient's clinical condition. Given the pathophysiological and therapeutic similarities between KD and multisystem inflammatory syndrome, it could be considered a therapeutic option.
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Affiliation(s)
- Miodrag Sreckovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Serbia; Clinic for Cardiology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | | | - Biljana Popovska Jovicic
- Clinic for Infectious Diseases, University Clinical Center Kragujevac, Kragujevac, Serbia; Department of Infectious Diseases, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Slobodan Jankovic
- Department of Pharmacology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; Department of Pharmacology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Rasa Medovic
- Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; Department of Pediatrics, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Milica Begovic Cvetkovic
- Department for Rheumatology, Clinic for Internal Medicine, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Tatjana Lazarevic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Serbia; Department of Emergency Medicine, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Milos Milosavljevic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; Department of Pathology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Stefan Simovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Serbia; Clinic for Cardiology, University Clinical Center Kragujevac, Kragujevac, Serbia.
| | - Rada Vucic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Serbia; Clinic for Cardiology, University Clinical Center Kragujevac, Kragujevac, Serbia
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11
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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; 54:7-18. [PMID: 35306376 DOI: 10.1016/j.hrtlng.2022.03.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The exact prevalence of Multisystem Inflammatory Syndrome in Adults (MIS-A) is largely unknown. Vague and multiple definitions and treatment options often add to the confusion on how to label the diagnosis with certainty. OBJECTIVES The objective of the study was to determine the demographic profile, clinical presentation, laboratory findings and outcomes of MIS-A in COVID-19. METHODS A systematic review was conducted after registering with PROSPERO. Multiple databases were systematically searched to encompass studies characterizing MIS-A from 1st January 2020 up to 31st August 2021. The inclusion criteria were- to incorporate all published or in press peer-reviewed articles reporting cases of MIS-A. We accepted the following types of studies: case reports, case-control, case series, cross-sectional studies and letters to the editors that incorporated clinical, laboratory, imaging, as well as the hospital course of MIS-A patients. The exclusion criteria for the review were- articles not in English, only abstracts published, no data on MIS-A and articles which have focus on COVID-19, and not MIS-A. Two independent authors screened the articles, extracted the data, and assessed the risk of bias. RESULTS A total of 53 articles were included in this review with a sample size of 79 cases. Majority of the patients were males (73.4%) with mean age of 31.67±10.02 years. Fever (100%) and skin rash (57.8%) were the two most common presenting symptoms. Echocardiographic data was available for 73 patients of whom 41 (73.2%) had reduced left ventricular ejection fraction. Cardiovascular system was most frequently involved (81%) followed by gastrointestinal (73.4%) and mucocutaneous (51.9%) involvement. Anti-inflammatory therapies used in treatment included steroids (60.2%), intravenous immunoglobulin (37.2%) and biologics (10.2%). Mean duration of the hospital stay was 11.67±8.08 days. Data regarding the outcomes was available for all 79 subjects of whom 4 (5.1%) died during course of hospital stay. CONCLUSIONS Emergence of MIS-A calls for further large-scale studies to establish standard case definitions and definite treatment guidelines.
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Affiliation(s)
- Shekhar Kunal
- Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical, Education and Research, Delhi, India.
| | - Pranav Ish
- Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical, College and Safdarjung Hospital, Delhi 110029, India
| | - Pirabu Sakthivel
- Department of Otorhinolaryngology and Head-Neck Surgery, Kovai Medical Centre, Hospital, Coimbatore 641014, India
| | - Nipun Malhotra
- Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical, College and Safdarjung Hospital, Delhi 110029, India
| | - Kashish Gupta
- Department of Medicine, SG Diabetes Center, New Delhi, India
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Singh G, Osman A, Ryad R, Nguyen P, Itzkowitz R, Maharam E. Multisystem Inflammatory Syndrome in an Adult Who Received Casirivimab-Imdevimab (REGEN-COV). Cureus 2022; 14:e27353. [PMID: 36046289 PMCID: PMC9417327 DOI: 10.7759/cureus.27353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/05/2022] Open
Abstract
Multisystem inflammatory syndrome in adults (MIS-A) is a systemic inflammatory syndrome that presents with a heterogeneous collection of signs and symptoms in adults. Here we present a case of a 38-year-old male who met the case definition of the MIS-A four weeks after a mild, symptomatic case of coronavirus disease 2019 (COVID-19) despite receiving casirivimab-imdevimab (REGEN-COV). Given the presence of signs and symptoms consistent with MIS-A, the patient was started on intravenous immune globulin (IVIG) and IV methylprednisolone. He promptly demonstrated clinical improvement over the next several days.
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Affiliation(s)
- Gurdeep Singh
- Internal Medicine, AdventHealth - Orlando, Orlando, USA
| | - Alsayed Osman
- Internal Medicine, AdventHealth - Orlando, Orlando, USA
| | - Robert Ryad
- Internal Medicine, AdventHealth - Orlando, Orlando, USA
| | - Phuong Nguyen
- Internal Medicine, AdventHealth - Orlando, Orlando, USA
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13
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Razzak AN, Janardan A, Shah I, Jha P, Abdelgadir Y. A Case of Multisystem Inflammatory Syndrome in an Immunosuppressed Adult. Cureus 2022; 14:e25635. [PMID: 35673620 PMCID: PMC9165724 DOI: 10.7759/cureus.25635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/24/2022] Open
Abstract
Multisystem inflammatory syndrome in an adult (MIS-A) is a rare immunological complication that gained prominence after the coronavirus disease 2019 pandemic. Patients with MIS-A often clinically present with non-specific generalized symptoms, such as fever, myalgia, or fatigue, making the diagnosis difficult. In this article, we present an unusual case of MIS-A in a 50-year-old male that raises the question of whether the immune system's dysregulation will demonstrate differing criteria of signs and symptoms for a patient on sustained immunosuppression as opposed to the non-immunosuppressed population.
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Affiliation(s)
- Abrahim N Razzak
- School of Medicine, Medical College of Wisconsin, Milwaukee, USA
| | | | - Ipsit Shah
- School of Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Pinky Jha
- Internal Medicine, Medical College of Wisconsin, Milwaukee, USA
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14
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Miyazato Y, Yamamoto K, Yamada G, Kubota S, Ishikane M, Sugiyama M, Ueno M, Matsunaga A, Miyoshi-Akiyama T, Ishizaka Y, Ohmagari N. Multisystem Inflammatory Syndrome in Adult after First Dose of mRNA Vaccine. Emerg Infect Dis 2022; 28:870-872. [PMID: 35148495 PMCID: PMC8962876 DOI: 10.3201/eid2804.212585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A 32-year-old man in Japan experienced respiratory failure after receiving the first dose of coronavirus disease (COVID-19) vaccine. He was treated with noninvasive ventilation and corticosteroids. Serologic test results suggested previous COVID-19; therefore, he received a diagnosis of multisystem inflammatory syndrome. COVID-19 vaccination could be a trigger for this condition.
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15
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Newman S, Zou F, Madan S, Sims D. Multisystem inflammatory syndrome in adults (MIS-A) following COVID-19 requiring venoarterial extracorporeal membrane oxygenation. BMJ Case Rep 2022; 15:15/3/e247427. [PMID: 35256368 PMCID: PMC8905938 DOI: 10.1136/bcr-2021-247427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The SARS-CoV-2 virus has caused a global pandemic with serious impact around the world. Patients most commonly present with severe lung involvement and acute respiratory failure; however, multisystem inflammatory syndrome in adults (MIS-A) is a known-although rare-complication. We present a case of a 49-year-old patient who presented with combined cardiogenic and vasodilatory shock and was diagnosed with MIS-A. He initially required venoarterial extracorporeal membrane oxygenation and Impella for haemodynamic support but was able to be weaned off these devices with complete recovery of left ventricular systolic function. This case demonstrates that MIS-A may present as haemodynamic collapse in adults, but complete recovery is possible with proper haemodynamic support.
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Affiliation(s)
- Seth Newman
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Fengwei Zou
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Shivank Madan
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Daniel Sims
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
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16
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Behzadi F, Ulloa NA, Danckers M. Multisystem inflammatory syndrome in adults: a case report and review of the literature. J Med Case Rep 2022; 16:102. [PMID: 35241158 PMCID: PMC8892111 DOI: 10.1186/s13256-022-03295-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/25/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The current coronavirus disease pandemic has brought recognition of multisystem inflammatory syndrome in adults as a de novo entity, temporally associated with severe acute respiratory syndrome coronavirus 2 viral infection in adults. Hypothesis about its true pathophysiology remains controversial. CASE REPORT The patient was a 22-year-old African American female presenting to the emergency department with fever, sore throat, and neck swelling for the past 3 days. During her initial emergency department visit, her blood pressure was stable at 110/57 mmHg, temperature of 39.4 °C, and heart rate of 150 beats per minute. While in the emergency department, she received broad-spectrum antibiotics (vancomycin and ceftriaxone) and 30 cc/kg bolus of normal saline. Originally, she was admitted to a telemetry floor. The following night, a rapid response code was called due to hypotension. At that time, her blood pressure was 80/57 mmHg. She appeared comfortable without signs of respiratory distress. She received intravenous fluids and vasopressors, and was transferred to the intensive care unit. The patient had reported a previous coronavirus disease infection a few weeks prior. She was diagnosed and treated for multisystem inflammatory syndrome in adults. Intravenous immunoglobulin infusion was initiated and completed on hospital day 5. She was weaned off vasopressors by day 6, and discharged home on day 11. CONCLUSION Our case report is an example of the presentation, diagnosis, and management of multisystem inflammatory syndrome. Our research into previous case reports illustrates the wide range of presentations, degree of end organ damage, and treatment modalities. This diagnosis needs to be considered in the presence of recent coronavirus disease infection with new-onset end organ failure, as prompt diagnosis and treatment is crucial for better outcomes.
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Affiliation(s)
- Fardad Behzadi
- Department of Internal Medicine, Aventura Hospital and Medical Center, Miami, FL, USA
| | - Nicolas A Ulloa
- Department of Emergency Medicine, Aventura Hospital and Medical Center, Miami, FL, USA.
| | - Mauricio Danckers
- Department of Critical Care, Aventura Hospital and Medical Center, Miami, FL, USA
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17
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Conway SR, Lazarski CA, Field NE, Jensen-Wachspress M, Lang H, Kankate V, Durkee-Shock J, Kinoshita H, Suslovic W, Webber K, Smith K, Cohen JI, Burbelo PD, Zhang A, Teach SJ, Ibeh T, Delaney M, DeBiasi RL, Keller MD, Bollard CM. SARS-CoV-2-Specific T Cell Responses Are Stronger in Children With Multisystem Inflammatory Syndrome Compared to Children With Uncomplicated SARS-CoV-2 Infection. Front Immunol 2022; 12:793197. [PMID: 35116027 PMCID: PMC8803660 DOI: 10.3389/fimmu.2021.793197] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/22/2021] [Indexed: 12/21/2022] Open
Abstract
Background Despite similar rates of infection, adults and children have markedly different morbidity and mortality related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Compared to adults, children have infrequent severe manifestations of acute infection but are uniquely at risk for the rare and often severe Multisystem Inflammatory Syndrome in Children (MIS-C) following infection. We hypothesized that these differences in presentation are related to differences in the magnitude and/or antigen specificity of SARS-CoV-2-specific T cell (CST) responses between adults and children. We therefore set out to measure the CST response in convalescent adults versus children with and without MIS-C following SARS-CoV-2 infection. Methods CSTs were expanded from blood collected from convalescent children and adults post SARS-CoV-2 infection and evaluated by intracellular flow cytometry, surface markers, and cytokine production following stimulation with SARS-CoV-2-specific peptides. Presence of serum/plasma antibody to spike and nucleocapsid was measured using the luciferase immunoprecipitation systems (LIPS) assay. Findings Twenty-six of 27 MIS-C patients, 7 of 8 non-MIS-C convalescent children, and 13 of 14 adults were seropositive for spike and nucleocapsid antibody. CST responses in MIS-C patients were significantly higher than children with uncomplicated SARS-CoV-2 infection, but weaker than CST responses in convalescent adults. Interpretation Age-related differences in the magnitude of CST responses suggest differing post-infectious immunity to SARS-CoV-2 in children compared to adults post uncomplicated infection. Children with MIS-C have CST responses that are stronger than children with uncomplicated SARS-CoV-2 infection and weaker than convalescent adults, despite near uniform seropositivity.
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Affiliation(s)
- Susan R. Conway
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, United States
- Division of Critical Care Medicine, Children’s National Hospital, Washington, DC, United States
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Christopher A. Lazarski
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, United States
| | - Naomi E. Field
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, United States
| | - Mariah Jensen-Wachspress
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, United States
| | - Haili Lang
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, United States
| | - Vaishnavi Kankate
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, United States
| | - Jessica Durkee-Shock
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, United States
- Laboratory of Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Hannah Kinoshita
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, United States
- Division of Hematology and Oncology, Children’s National Hospital, Washington, DC, United States
| | - William Suslovic
- Division of Pathology and Laboratory Medicine, Children’s National Hospital, Washington, DC, United States
| | - Kathleen Webber
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, United States
| | - Karen Smith
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
- Department of Pediatrics, Children’s National Hospital, Washington, DC, United States
| | - Jeffrey I. Cohen
- Laboratory of Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Peter D. Burbelo
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, United States
| | - Anqing Zhang
- Division of Biostatistics and Study Methodology, Children’s National Hospital, Washington, DC, United States
| | - Stephen J. Teach
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
- Center for Translational Research, Children’s National Hospital, Washington, DC, United States
| | - Trisha Ibeh
- Center for Translational Research, Children’s National Hospital, Washington, DC, United States
| | - Meghan Delaney
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
- Division of Pathology and Laboratory Medicine, Children’s National Hospital, Washington, DC, United States
| | - Roberta L. DeBiasi
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
- Division of Infectious Diseases, Children’s National Hospital, Washington, DC, United States
| | - Michael D. Keller
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, United States
- Division of Allergy and Immunology, Children’s National Hospital, Washington, DC, United States
- GW Cancer Center, George Washington University, Washington, DC, United States
| | - Catherine M. Bollard
- Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, United States
- GW Cancer Center, George Washington University, Washington, DC, United States
- *Correspondence: Catherine M. Bollard,
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18
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Park JW, Yu SN, Chang SH, Ahn YH, Jeon MH. Multisystem Inflammatory Syndrome in an Adult after COVID-19 Vaccination: a Case Report and Literature Review. J Korean Med Sci 2021; 36:e312. [PMID: 34811978 PMCID: PMC8608920 DOI: 10.3346/jkms.2021.36.e312] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/21/2021] [Indexed: 01/14/2023] Open
Abstract
As the number of people vaccinated increases, people who complain of adverse reactions continue to occur. We experienced a case characterized by low blood pressure, persistent fever, edema due to increased systemic vascular permeability, and systemic inflammation confirmed by image and laboratory examinations after ChAdOx1 coronavirus disease 2019 (COVID-19) vaccination. The diagnostic criteria for multisystem inflammatory syndrome (MIS) in adults are known as fever of 3 days or more in adults, 2 or more mucocutaneous/gastrointestinal/neurologic symptoms, elevation of inflammatory markers, and clinical/imaging diagnosis of heart failure. A 67-year-old man who was medicated for hypertension and diabetes was admitted complaining of fever, maculopapular rash, diarrhea, headache, chills, and dizziness 6 days after the first vaccination of ChAdOx1 nCoV-19 in Korea. The COVID-19 test was negative but with low blood pressure, leukocytosis, skin rash, pulmonary edema, and increased inflammation markers. His lab findings and clinical course were consistent with those of MIS after COVID-19 vaccination. He was medicated with methylprednisolone 1 mg/kg and diuretics and recovered rapidly. He was discharged after 2 weeks and confirmed cure at outpatient clinic. We report an MIS case after COVID-19 vaccination in Korea.
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Affiliation(s)
- Jung Wan Park
- Department of Internal Medicine, Division of Infectious Disease, Soonchunhyang University Hospital, Cheonan, Korea
| | - Shi Nae Yu
- Department of Internal Medicine, Division of Infectious Disease, Soonchunhyang University Hospital, Cheonan, Korea
| | - Sung Hae Chang
- Department of Internal Medicine, Division of Rheumatology, Soonchunhyang University Hospital, Cheonan, Korea
| | - Young Hyeon Ahn
- Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea
| | - Min Hyok Jeon
- Department of Internal Medicine, Division of Infectious Disease, Soonchunhyang University Hospital, Cheonan, Korea.
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19
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Danieli MG, Piga MA, Paladini A, Longhi E, Mezzanotte C, Moroncini G, Shoenfeld Y. Intravenous immunoglobulin as an important adjunct in the prevention and therapy of coronavirus 2019 disease. Scand J Immunol 2021; 94:e13101. [PMID: 34940980 PMCID: PMC8646640 DOI: 10.1111/sji.13101] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 12/15/2022]
Abstract
The coronavirus disease-19 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) challenged globally with its morbidity and mortality. A small percentage of affected patients (20%) progress into the second stage of the disease clinically presenting with severe or fatal involvement of lung, heart and vascular system, all contributing to multiple-organ failure. The so-called 'cytokines storm' is considered the pathogenic basis of severe disease and it is a target for treatment with corticosteroids, immunotherapies and intravenous immunoglobulin (IVIg). We provide an overview of the role of IVIg in the therapy of adult patients with COVID-19 disease. After discussing the possible underlying mechanisms of IVIg immunomodulation in COVID-19 disease, we review the studies in which IVIg was employed. Considering the latest evidence that show a link between new coronavirus and autoimmunity, we also discuss the use of IVIg in COVID-19 and anti-SARS-CoV-2 vaccination related autoimmune diseases and the post-COVID-19 syndrome. The benefit of high-dose IVIg is evident in almost all studies with a rapid response, a reduction in mortality and improved pulmonary function in critically ill COVID-19 patients. It seems that an early administration of IVIg is crucial for a successful outcome. Studies' limitations are represented by the small number of patients, the lack of control groups in some and the heterogeneity of included patients. IVIg treatment can reduce the stay in ICU and the demand for mechanical ventilation, thus contributing to attenuate the burden of the disease.
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Affiliation(s)
- Maria Giovanna Danieli
- Clinica Medica, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di Ancona and DISCLIMOUniversità Politecnica delle Marche, Clinica MedicaAnconaItaly
- School of Specialisation in Allergology and Clinical Immunology, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di AnconaUniversità Politecnica delle MarcheAnconaItaly
| | - Mario Andrea Piga
- School of Specialisation in Allergology and Clinical Immunology, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di AnconaUniversità Politecnica delle MarcheAnconaItaly
| | - Alberto Paladini
- School of Specialisation in Internal Medicine, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di AnconaUniversità Politecnica delle MarcheAnconaItaly
| | - Eleonora Longhi
- Scuola di Medicina e ChirurgiaAlma Mater StudiorumUniversità degli Studi di BolognaBolognaItaly
| | - Cristina Mezzanotte
- School of Specialisation in Internal Medicine, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di AnconaUniversità Politecnica delle MarcheAnconaItaly
| | - Gianluca Moroncini
- Clinica Medica, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di Ancona and DISCLIMOUniversità Politecnica delle Marche, Clinica MedicaAnconaItaly
- School of Specialisation in Internal Medicine, Dipartimento di Medicina Interna, AOU Ospedali Riuniti di AnconaUniversità Politecnica delle MarcheAnconaItaly
| | - Yehuda Shoenfeld
- Ariel UniversityArielIsrael
- The Zabludowicz Center for Autoimmune DiseasesSheba Medical CenterRamat GanIsrael
- Saint Petersburg State UniversitySt. PetersburgRussia
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)MoscowRussia
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20
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An Intriguing Case of Multisystem Inflammatory Syndrome in an Adult Patient with Remote Infection with COVID-19 and Acute Chlamydia. Case Rep Infect Dis 2021; 2021:6620240. [PMID: 34631180 PMCID: PMC8494571 DOI: 10.1155/2021/6620240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/11/2021] [Accepted: 09/18/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction COVID-19 is associated with a broad range of immune inflammatory phenomena, with different manifestations in adults and children. We describe a case of COVID-19-related multisystem inflammatory syndrome in an adult (MIS-A), similar to that described in children (MIS-C), which may have been set off by an unrelated secondary infection. Case A 27-year-old male patient presented with acute epididymitis secondary to acute Chlamydia infection that progressed to multisystem inflammatory failure with respiratory failure requiring endotracheal intubation and mechanical ventilation, cardiogenic shock with heart failure, and gastrointestinal and renal dysfunction. He tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase-polymerase chain reaction on a nasopharyngeal swab thrice within 4 days of presentation, but positive for SARS-CoV-2 immunoglobulin G antibody signifying remote infection. The patient was treated with tocilizumab and steroids, along with doxycycline for concurrent Chlamydia infection, resulting in dramatic improvement in all organ function. We suspect that C. trachomatis infection in this instance may have triggered an aberrant immune response that was shaped by prior exposure to SARS-CoV-2. Conclusion We present a case of an adult patient with acute Chlamydia trachomatis infection occurring in the wake of asymptomatic (or at least unrecognized) COVID-19 resulting in MIS-A. Clinicians should be alert to the possibility of other such unusual reactions occurring in the aftermath of COVID-19. This case also highlights the importance for clinicians who care for adult patients of being familiar with the multisystem inflammatory syndrome of children, as an identical syndrome may occur in adult patients.
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21
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A Systematic Review of Severe Neurological Manifestations in Pediatric Patients with Coexisting SARS-CoV-2 Infection. Neurol Int 2021; 13:410-427. [PMID: 34449704 PMCID: PMC8396020 DOI: 10.3390/neurolint13030041] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 01/13/2023] Open
Abstract
SARS-CoV-2 infection in children produces mild respiratory symptoms or no symptoms at all in most cases. Some pediatric patients develop a severe complication associated with high mortality, the multisystem inflammatory syndrome in children (MIS-C). In both scenarios, there are reports of neurological manifestations. This article aims to review the cases of pediatric patients with severe neurological issues and a coexisting positive SARS-CoV-2 test. A literature search was performed between March 2020 and May 2021. The results included the data from 41 studies, with 159 children with severe neurological manifestations, within an age range from 24 h to 17 years. The neurological disorders included 38 cases with stroke, 32 with encephalitis, 22 with encephalopathy, and 10 with Guillain–Barre syndrome. Sixty-five out of 159 cases with severe neurological manifestations were diagnosed with MIS-C. Direct neuroinvasion and the exaggerated immune response in some patients seem to be the most critical factors triggering these manifestations. Further research in the ongoing pandemic is needed to elucidate the precise mechanism.
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