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Multisystem inflammatory syndrome associated with SARS-CoV-2 (MIS-C) is a rare, excessive immune response to COVID-19 described in children. Compiling multiple case reports, this case series describes 27 cases of multisystem inflammatory syndrome in adults (MIS-A) aged 21 to 50 years, 3 of whom died due to the MIS-A. Diagnostic criteria for MIS-A included hospitalization without evidence of severe respiratory illness to distinguish MIS-A from severe COVID-19 infection, extrapulmonary organ pathology (shock, cardiac dysfunction, thromboembolic events), and laboratory evidence of acute inflammation (elevated CRP, ferritin, D-dimer, IL-6).
This study offers the most comprehensive compilation of MIS-A patients to date while highlighting unknown aspects of the syndrome, including the pathophysiology, relationship with COVID-19 infection, and median time to onset. The authors acknowledge that this case series represents a convenience sample, and that recognition of additional cases may lead to revision of the diagnostic criteria over time.
– Emmett A. Kistler, MD
This abstract is available on the publisher's site.
During the course of the coronavirus disease 2019 (COVID-19) pandemic, reports of a new multisystem inflammatory syndrome in children (MIS-C) have been increasing in Europe and the United States (1-3). Clinical features in children have varied but predominantly include shock, cardiac dysfunction, abdominal pain, and elevated inflammatory markers, including C-reactive protein (CRP), ferritin, D-dimer, and interleukin-6 (1). Since June 2020, several case reports have described a similar syndrome in adults; this review describes in detail nine patients reported to CDC, seven from published case reports, and summarizes the findings in 11 patients described in three case series in peer-reviewed journals (4-6). These 27 patients had cardiovascular, gastrointestinal, dermatologic, and neurologic symptoms without severe respiratory illness and concurrently received positive test results for SARS-CoV-2, the virus that causes COVID-19, by polymerase chain reaction (PCR) or antibody assays indicating recent infection. Reports of these patients highlight the recognition of an illness referred to here as multisystem inflammatory syndrome in adults (MIS-A), the heterogeneity of clinical signs and symptoms, and the role for antibody testing in identifying similar cases among adults. Clinicians and health departments should consider MIS-A in adults with compatible signs and symptoms. These patients might not have positive SARS-CoV-2 PCR or antigen test results, and antibody testing might be needed to confirm previous SARS-CoV-2 infection. Because of the temporal association between MIS-A and SARS-CoV-2 infections, interventions that prevent COVID-19 might prevent MIS-A. Further research is needed to understand the pathogenesis and long-term effects of this newly described condition.
Case Series of Multisystem Inflammatory Syndrome in Adults Associated With SARS-CoV-2 Infection — United Kingdom and United States, March–August 2020
MMWR Morb. Mortal. Wkly. Rep. 2020 Oct 09;69(40)1450-1456, SB Morris, NG Schwartz, P Patel, L Abbo, L Beauchamps, S Balan, EH Lee, R Paneth-Pollak, A Geevarughese, MK Lash, MS Dorsinville, V Ballen, DP Eiras, C Newton-Cheh, E Smith, S Robinson, P Stogsdill, S Lim, SE Fox, G Richardson, J Hand, NT Oliver, A Kofman, B Bryant, Z Ende, D Datta, E Belay, S Godfred-Cato