A CASE OF MULTISYSTEM INFLAMMATORY SYNDROME IN AN ADULT PATIENT PRESENTING AS SEPTIC SHOCK

ABSTRACT

TOPIC Critical Care TYPE Fellow Case Reports INTRODUCTION: Multisystem Inflammatory Syndrome-Adults (MIS-A) has been recognized as a severe illness requiring hospitalization in a person aged 21 or older, with laboratory evidence of current or previous SARS-CoV-2 infection, severe extra-pulmonary organ dysfunction, laboratory evidence of severe inflammation and minimal of respiratory disease (1). It was initially recognized in children as Kawasaki disease-like illness after COVID-19. There have been several cases reported in children, however, only a few reported in adults. CASE PRESENTATION We present the case of a 49-year old woman with chief complaints of generalized weakness, sore throat, and lower abdominal pain. Her medical history was significant for COVID-19 infection 2 months prior. On presentation she was hemodynamically unstable with heart rate of 134/min, blood pressure of 86/36 mm Hg, respiratory rate of 32/min, oxygen saturation of 92% on room air and temperature of 102.8 F. Physical examination was positive for dry mucous membranes, pharyngeal erythema, cervical lymphadenopathy and lower abdominal tenderness. Initial investigations were consistent with DIC and septic shock. She was treated with multiple vasopressors. She was placed on intravenous broad-spectrum antibiotics. Her SARS-CoV-2 PCR was negative, but SARS-CoV-2 IgG and IgM antibodies came back positive. Her chest x-ray was unremarkable. She also had elevated inflammatory markers including C-reactive protein, lactate dehydrogenase and ferritin. Due to her history of Covid-19 infection, positive antibodies to SARS-CoV-2, high grade fever, elevated inflammatory markers and multi-organ dysfunction a diagnosis of multisystem inflammatory syndrome was made. Her case was reported and discussed with CDC team as well. Patient was started on intravenous high-dose corticosteroids. After starting therapy, significant improvement was seen in patient's clinical status. Her corticosteroids were tapered off and patient was eventually discharged home in stable condition. DISCUSSION: This case highlights that adult patients with SARS-CoV-2 infection can develop a hyperinflammatory syndrome even as late as 60 days. Previously the onset of MIS-A has been reported 2-5 weeks after initial diagnosis (1). These patients can have minimal respiratory symptoms. The pathophysiology of MIS-A is unclear. High clinical suspicion in conjunction with antibody, viral testing, and inflammatory markers will assist in the diagnosis. Treatment used for MIS-A includes supportive care, steroids, anticoagulation, antivirals, and/or IL-6 inhibitors. CONCLUSIONS: This case emphasizes the importance of early recognition and prompt treatment of multisystem inflammatory syndrome in adults to prevent significant morbidity and mortality. Considering rarity and novelty of this disease, physicians should have high clinical suspicion in adults with history of COVID-19 infection. REFERENCE #1 CDC. Information for healthcare providers about multisystem inflammatory syndrome in adults (MIS-A). Atlanta, GA US Department of Health and Human Services, CDC;2020. https//www.cdc.gov/mis-c/hcp/ DISCLOSURES No relevant relationships by Manaquibb Zain Khan, source=Web Response No relevant relationships by SOHAIB KHAN, source=Web Response No relevant relationships by faisal mahfooz, source=Web Response No relevant relationships by Mehul Patel, source=Web Response