Multiorgan Inflammatory Syndrome in Adults MIS-A Post SARS-CoV-2 Infection: A Novel Clinical Enigma

Area of Science:

• Critical care medicine
• Infectious diseases
• Rheumatology

Background:

• Multisystem inflammatory syndrome in adults (MIS-A) is an emergent syndrome in the convalescent phase of COVID-19.
• MIS-A shares similarities with MIS in children (MIS-C), a recognized severe post-COVID-19 illness.
• This study highlights MIS-A as a serious clinical entity with potentially fatal outcomes if not promptly diagnosed and treated.

Observation:

• Four rare cases of MIS-A presented at Goa Medical College between June and November 2021.
• Patients ranged from 29-70 years old, all with a history of recent (mild) COVID-19 infection.
• Cases exhibited diverse symptoms, laboratory abnormalities, and severe systemic inflammatory response with multiple organ dysfunction.

Findings:

• All four MIS-A cases met CDC 2020 criteria, presenting with elevated proinflammatory markers.
• Patients displayed multi-organ dysfunction, indicating a severe systemic inflammatory response.
• A history of COVID-19 infection was noted in all cases, though primary infection symptoms were often mild and unnoticed.

Implications:

• MIS-A should be considered in patients with recent COVID-19 presenting with multi-organ dysfunction, after excluding sepsis.
• Early recognition and management are vital to prevent fatal outcomes associated with MIS-A.
• The study underscores the importance of considering MIS-A even when prior COVID-19 infection was asymptomatic or mild.