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Medullary haemorrhagic interstitial nephritis in multisystem inflammatory syndrome in adults following COVID-19

Hiroki Matsuoka1, Hideaki Shimizu2, Hiroshi Kitamura3

  • 1Nephrology, Daido Hospital, Nagoya, Japan.

BMJ Case Reports
|July 10, 2026
PubMed

Insights

Multisystem inflammatory syndrome in adults (MIS-A) following COVID-19 can cause kidney damage. A rare case revealed medullary haemorrhagic interstitial nephritis, highlighting the need for early MIS-A diagnosis and treatment.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pathology

Background:

  • Multisystem inflammatory syndrome in adults (MIS-A) is a serious post-COVID-19 complication.
  • Renal involvement is frequent in MIS-A, but detailed histopathological data remain limited.

Purpose of the Study:

  • To describe the histopathological findings of renal injury in a MIS-A case.
  • To emphasize the importance of recognizing MIS-A for prompt treatment.

Main Methods:

  • Case report of a previously healthy male in his 60s presenting with MIS-A symptoms post-COVID-19.
  • Clinical assessment, laboratory tests, and renal biopsy were performed.
  • Treatment with corticosteroids was initiated.

Main Results:

  • The patient presented with fever, diarrhea, glossitis, and digital swelling 3 weeks after COVID-19.
  • Renal function deteriorated, leading to a MIS-A diagnosis.
  • Renal biopsy revealed medullary haemorrhagic interstitial nephritis with a preserved cortex, suggesting immune-mediated endothelial injury.

Conclusions:

  • Medullary haemorrhagic interstitial nephritis is a potential, albeit uncommon, pathological finding in MIS-A.
  • Early recognition and corticosteroid treatment are crucial for managing MIS-A and preventing severe outcomes.
Keywords:
Acute renal failureCOVID-19SARS-CoV-2

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