Clinical and biological heterogeneity of multisystem inflammatory syndrome in adults following SARS-CoV-2 infection: a case series

Kaia E Barth; Natasha Spottiswoode; Charlotte Hurabielle; Lakshmi Subbaraj; COMET Consortium; Carolyn S Calfee; Michael A Matthay; Sarah French; Andrew Connolly; Stephen M Hewitt; Kevin M Vannella; Christopher Barnett; Charles R Langelier; Sarah Patterson

doi:10.3389/fmed.2023.1187420

Clinical and biological heterogeneity of multisystem inflammatory syndrome in adults following SARS-CoV-2 infection: a case series

Front Med (Lausanne). 2023 Jul 6:10:1187420. doi: 10.3389/fmed.2023.1187420. eCollection 2023.

Authors

Affiliations

¹ Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.
² Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, United States.
³ Division of Rheumatology, University of California, San Francisco, San Francisco, CA, United States.
⁴ Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco, San Francisco, CA, United States.
⁵ Department of Pathology, University of California, San Francisco, San Francisco, CA, United States.
⁶ Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States.
⁷ Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States.
⁸ Laboratory of Virology, National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States.
⁹ Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States.
¹⁰ Chan Zuckerberg Biohub, San Francisco, CA, United States.

Abstract

Importance: Multisystem inflammatory syndrome in adults (MIS-A) is a poorly understood complication of SARS-CoV-2 infection with significant morbidity and mortality.

Objective: Identify clinical, immunological, and histopathologic features of MIS-A to improve understanding of the pathophysiology and approach to treatment.

Design: Three cases of MIS-A following SARS-CoV-2 infection were clinically identified between October 2021 - March 2022 using the U.S. Centers for Disease Control and Prevention diagnostic criteria. Clinical, laboratory, imaging, and tissue data were assessed.

Findings: All three patients developed acute onset cardiogenic shock and demonstrated elevated inflammatory biomarkers at the time of hospital admission that resolved over time. One case co-occurred with new onset Type 1 diabetes and sepsis. Retrospective analysis of myocardial tissue from one case identified SARS-CoV-2 RNA. All three patients fully recovered with standard of care interventions plus immunomodulatory therapy that included intravenous immunoglobulin, corticosteroids, and in two cases, anakinra.

Conclusion: MIS-A is a severe post-acute sequela of COVID-19 characterized by systemic elevation of inflammatory biomarkers. In this series of three cases, we find that although clinical courses and co-existent diseases vary, even severe presentations have potential for full recovery with prompt recognition and treatment. In addition to cardiogenic shock, glucose intolerance, unmasking of autoimmune disease, and sepsis can be features of MIS-A, and SARS-CoV-2 myocarditis can lead to a similar clinical syndrome.

Keywords: COVID-19; DKA; MIS-A; SARS-CoV-2; multisystem inflammatory syndrome; myocarditis.

Publication types

Case Reports

Abstract

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