Multisystem inflammatory syndrome in adults after acute coronavirus disease 2019 in a Japanese woman: A case report

Multisystem Inflammatory Syndrome of the Adults (MIS-A) - The undercover threat for young adults. A systematic review and meta-analysis of medical cases

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.

COVID–19後に成人多系統炎症性症候群および特徴的な眼症状を呈した1例(A case of multisystem inflammatory syndrome in adults and characteristic ocular symptoms after COVID–19)

Multisystem inflammatory syndrome in adults (MIS–A) is a rare but serious condition which occurs after weeks of getting sick from COVID–19. Here, we report a 54–year–old MIS–A female patient who presented with multiple organ failure (cardiovascular and gastrointestinal involvement) and markedly elevated inflammatory markers three weeks after recovering from COVID–19. The patient was characterized by photophobia and epiphora, suggestive of uveitis. Symptoms improved upon intravenous immunoglobulin and steroids. The patient was discharged on the nineteenth day of hospitalization without any recurrences. Clinicians should be highly suspicious of MIS–A in recent COVID–19 patients presenting with multiple organ failure and ocular symptoms.