Case Report: Adult Post-COVID-19 Multisystem Inflammatory Syndrome and Thrombotic Microangiopathy

Front Immunol. 2021 Jun 23:12:680567. doi: 10.3389/fimmu.2021.680567. eCollection 2021.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. A clinical series of Kawasaki-like multisystem inflammatory syndrome (MIS), occurring after SARS-CoV-2 infection, have been described in children (MIS-C) and adults (MIS-A), but the pathophysiology remains unknown.

Case presentation: We describe a case of post-COVID-19 MIS-A in a 46-year-old man with biopsy-proven renal thrombotic microangiopathy (TMA). Specific complement inhibition with eculizumab was initiated promptly and led to a dramatic improvement of renal function.

Conclusion: Our case suggests that that TMA could play a central role in the pathophysiology of post-COVID-19 MIS-A, making complement blockers an interesting therapeutic option.

Keywords: COVID-19; case report; complement system; eculizumab; multisystem inflammatory syndrome; thrombotic microangiopathy.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • COVID-19 / diagnosis*
  • COVID-19 Drug Treatment
  • Complement Inactivating Agents / therapeutic use*
  • Humans
  • Kidney / metabolism*
  • Kidney / pathology
  • Male
  • Middle Aged
  • Pandemics
  • Recovery of Function
  • SARS-CoV-2 / physiology*
  • Systemic Inflammatory Response Syndrome / diagnosis*
  • Systemic Inflammatory Response Syndrome / drug therapy
  • Thrombotic Microangiopathies / diagnosis*
  • Thrombotic Microangiopathies / drug therapy

Substances

  • Antibodies, Monoclonal, Humanized
  • Complement Inactivating Agents
  • adult multisystem inflammatory disease, COVID-19 related
  • eculizumab