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Multisystem inflammatory syndrome in adults (MIS-A), is a rare post-infectious complication of COVID-19. Clinicians should be alert for possible MIS-A in the weeks after a surge in COVID-19 cases.

Case report

A 25-year-old, otherwise well, SARS-CoV-2 unvaccinated Tongan male presented to hospital in November 2021 with one day of fever, painful swollen toes, an itchy rash and diarrhoea. He had recently recovered from uncomplicated, confirmed COVID-19 (symptom onset 30 days prior) and had a resolving dry cough. On initial assessment, he was febrile (38.6°C), tachycardic (128bpm), tachypnoiec (26/min), normotensive (119/74mmHg) and had normal oxygen saturation (97% on air). He had an urticarial rash in his left axilla, diffuse erythema and swelling of the dorsal left foot and toes, and dactylitis of the left third finger. The examination was otherwise unremarkable. Initial investigations included a CRP of 98mg/L, neutrophilia of 9.5x10[[9]]/L, abnormal liver function tests, negative nasopharyngeal SARS-CoV-2 PCR and normal chest X-ray (see Table 2).

Over 48 hours his dactylitis and rash resolved; however, his fevers and inflammatory markers worsened. Further investigations were requested (Table 2) and empiric antibiotics initiated (Table 1). Infectious disease consultation identified conjunctival injection and cracked lips, concerning for possible MIS-A. Initial transthoracic echocardiogram (TTE) was normal. Rheumatology, cardiology and respiratory reviews supported probable MIS-A.

He started treatment with oral prednisone. This was associated with a temporary reduction in inflammatory response, before fever relapsed with tachycardia (130bpm), tachypnoea (30/min) and rising inflammatory and cardiac biomarkers (Tables 1 & 2). He was treated with intravenous immunoglobulin (IVIG), IV methylprednisone, IV ceftriaxone with IV clindamycin (for possible sepsis and toxic shock syndrome) and aspirin (due to reports of MIS-A-associated coronary artery aneurysm). Despite treatment he continued to deteriorate and on day 6 of illness developed cardiogenic shock with pulmonary oedema, requiring mechanical ventilation and inotropic support. A second TTE demonstrated acute severe biventricular dysfunction.

In association with continued glucocorticoid therapy, he recovered over the ensuing 10 days. Evaluation for alternative diagnoses was unrevealing (Table 2). Cardiac MRI on day 17 of illness showed normalised left ventricular function, with changes suggestive of acute myocarditis. CT coronary angiography did not demonstrate coronary artery aneurysm. He was discharged with a reducing dose of prednisone (10mg/week for 4 weeks) and remained well at follow-up two months later.

View Tables 1–3.

Discussion

This illustrative case of MIS-A is the first described in New Zealand. MIS-A is a rare, post-infectious complication of COVID-19.[[1,2]] Diagnosing MIS-A can be challenging, as the preceding COVID-19 illness may be mild or asymptomatic, and symptoms at presentation are non-specific (including fever, rash and gastrointestinal symptoms).[[3,4]] Investigations typically reveal markedly raised inflammatory markers and evidence of organ dysfunction. Cardiac involvement with reduced left ventricular ejection fraction is common, with evidence of myocarditis on cardiac MRI.[[2,5,6]] Coronary artery aneurysms have been described.[[7]] The CDC diagnostic criteria summarise these features and emphasise the importance of excluding other infectious and inflammatory diagnoses (Table 3).[[8]] Discussion with a multidisciplinary specialist group is recommended.

Treatment of MIS-A is extrapolated from paediatric experience of MIS-C (multisystem inflammatory syndrome of children), for which treatment with glucocorticoids and/or IVIG is recommended.[[9]] With aggressive treatment including ICU support, the prognosis of MIS-A appears reasonable, with a survival rate of 93%.[[2]]

Importantly, SARS-CoV-2 vaccination is likely to significantly reduce the risk of MIS-C.[[10]] Therefore, New Zealand might experience a lower burden of MIS-A and MIS-C than seen in pre-vaccine cohorts. Nevertheless, it is important that New Zealand clinicians are aware of these potentially life-threatening syndromes, as further cases are possible in the 2–5 weeks following a surge in community COVID-19 transmission (as has occurred in March 2022).[[2,9]]

Summary

Abstract

Multisystem inflammatory syndrome in adults (MIS-A), is a rare post-infectious complication of COVID-19. We describe an illustrative case of MIS-A in an otherwise well, SARS-CoV-2 unvaccinated 25-year-old Tongan man who presented to hospital 30 days after mild COVID-19 illness. We highlight the progression of his illness, including treatment in the Intensive Care Unit (ICU) for cardiogenic shock, and detail temporal evolution of clinical, laboratory and radiographic features of his illness. Clinicians should be alert for possible MIS-A in the weeks after a surge in COVID-19 cases.

Aim

Method

Results

Conclusion

Author Information

Tim Cutfield: Infectious Diseases and General Medicine Consultant, Department of Infectious Diseases, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand(ORCID ID 0000-0002-3995-1984). Yousif Saeed: Cardiology Registrar, Department of Cardiology, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand. Amanda Taylor: Paediatric Infectious Diseases Fellow, Department of Paediatric Infectious Diseases, Starship Children’s Hospital, 2 Park Road, Grafton, Auckland, New Zealand. Tim Askelund: General Medicine Consultant, Department of General Medicine, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand. Rob Bevan: Intensive Care Medicine Consultant, Department of Intensive Care, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand. Niels van Pelt: Cardiology Consultant, Department of Cardiology, Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand.

Acknowledgements

The authors would like to acknowledge the high-quality collaborative care provided for this patient by a multidisciplinary team of healthcare professionals at Middlemore Hospital, including members of the General Medical, Infectious Diseases, Cardiology, Rheumatology, Respiratory, Intensive Care, Physiotherapy and Occupational Health departments.

Correspondence

Dr Tim Cutfield: Department of Infectious Diseases, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand

Correspondence Email

Tim.cutfield@middlemore.co.nz

Competing Interests

Nil.

1) Morris SB, Schwartz NG, Patel P, Abbo L, Beauchamps L, Balan S, et al. Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection - United Kingdom and United States, March-August 2020. MMWR Morb Mortal Wkly Rep. 2020 Oct 9;69(40):1450-6.

2) Patel P, DeCuir J, Abrams J, Campbell AP, Godfred-Cato S, Belay ED. Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults: A Systematic Review. JAMA Netw Open. American Medical Association; 2021 Sep 1;4(9):e2126456-6.

3) Jones I, Bell LCK, Manson JJ, Last A, UCLH COVID Response Team. An adult presentation consistent with PIMS-TS. Lancet Rheumatol [Internet]. 2020 Sep;2(9):e520–1. Available from: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30234-4/fulltext

4) Kunal S, Ish P, Sakthivel P, Malhotra N, Gupta K. The emerging threat of multisystem inflammatory syndrome in adults (MIS-A) in COVID-19: A systematic review. Heart Lung [Internet]. 2022 Mar 14;54:7-18. Available from: https://www.sciencedirect.com/science/article/pii/S0147956322000589#!.

5) Aldeghaither S, Qutob R, Assanangkornchai N, Issa-Chergui B, Tam M, Larotondo R, et al. Clinical and Histopathologic Features of Myocarditis in Multisystem Inflammatory Syndrome (Adult)-Associated COVID-19. Crit Care Explor. 2022 Feb;10(2):e0630.

6) Hékimian G, Kerneis M, Zeitouni M, Cohen-Aubart F, Chommeloux J, Bréchot N, et al. Coronavirus Disease 2019 Acute Myocarditis and Multisystem Inflammatory Syndrome in Adult Intensive and Cardiac Care Units. Chest [Internet]. 2021 Feb;159(2):657-62. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476896/.

7) Diakite S, Bousdira N, Tachon G, Ackermann F, Groh M, Rohmer J. Regression of Coronary Aneurysms With Intravenous Immunoglobulins and Steroids for COVID-19 Adult Multisystem Inflammatory Syndrome. JACC Case Rep [Internet]. 2021 Apr;3(4):581-5. Available from: https://pubmed.ncbi.nlm.nih.gov/33782672/.

8) CDC Prevention Epicenters Program. Multisystem Inflammatory Syndrome in Adults (MIS-A) Case Definition Information for Healthcare Providers. 2020. Accessed March 2022. Available from: https://www.cdc.gov/mis/mis-a/hcp.html.

9) Dionne A, Son MBF, Randolph AG. An Update on Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2. Pediatr Infect Dis J. 2022 Jan 1;41(1):e6-e9.

10) Levy M, Recher M, Hubert H, Javouhey E, Fléchelles O, Leteurtre S, et al. Multisystem Inflammatory Syndrome in Children by COVID-19 Vaccination Status of Adolescents in France. JAMA. American Medical Association; 2022 Jan 18;327(3):281-3.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Multisystem inflammatory syndrome in adults (MIS-A), is a rare post-infectious complication of COVID-19. Clinicians should be alert for possible MIS-A in the weeks after a surge in COVID-19 cases.

Case report

A 25-year-old, otherwise well, SARS-CoV-2 unvaccinated Tongan male presented to hospital in November 2021 with one day of fever, painful swollen toes, an itchy rash and diarrhoea. He had recently recovered from uncomplicated, confirmed COVID-19 (symptom onset 30 days prior) and had a resolving dry cough. On initial assessment, he was febrile (38.6°C), tachycardic (128bpm), tachypnoiec (26/min), normotensive (119/74mmHg) and had normal oxygen saturation (97% on air). He had an urticarial rash in his left axilla, diffuse erythema and swelling of the dorsal left foot and toes, and dactylitis of the left third finger. The examination was otherwise unremarkable. Initial investigations included a CRP of 98mg/L, neutrophilia of 9.5x10[[9]]/L, abnormal liver function tests, negative nasopharyngeal SARS-CoV-2 PCR and normal chest X-ray (see Table 2).

Over 48 hours his dactylitis and rash resolved; however, his fevers and inflammatory markers worsened. Further investigations were requested (Table 2) and empiric antibiotics initiated (Table 1). Infectious disease consultation identified conjunctival injection and cracked lips, concerning for possible MIS-A. Initial transthoracic echocardiogram (TTE) was normal. Rheumatology, cardiology and respiratory reviews supported probable MIS-A.

He started treatment with oral prednisone. This was associated with a temporary reduction in inflammatory response, before fever relapsed with tachycardia (130bpm), tachypnoea (30/min) and rising inflammatory and cardiac biomarkers (Tables 1 & 2). He was treated with intravenous immunoglobulin (IVIG), IV methylprednisone, IV ceftriaxone with IV clindamycin (for possible sepsis and toxic shock syndrome) and aspirin (due to reports of MIS-A-associated coronary artery aneurysm). Despite treatment he continued to deteriorate and on day 6 of illness developed cardiogenic shock with pulmonary oedema, requiring mechanical ventilation and inotropic support. A second TTE demonstrated acute severe biventricular dysfunction.

In association with continued glucocorticoid therapy, he recovered over the ensuing 10 days. Evaluation for alternative diagnoses was unrevealing (Table 2). Cardiac MRI on day 17 of illness showed normalised left ventricular function, with changes suggestive of acute myocarditis. CT coronary angiography did not demonstrate coronary artery aneurysm. He was discharged with a reducing dose of prednisone (10mg/week for 4 weeks) and remained well at follow-up two months later.

View Tables 1–3.

Discussion

This illustrative case of MIS-A is the first described in New Zealand. MIS-A is a rare, post-infectious complication of COVID-19.[[1,2]] Diagnosing MIS-A can be challenging, as the preceding COVID-19 illness may be mild or asymptomatic, and symptoms at presentation are non-specific (including fever, rash and gastrointestinal symptoms).[[3,4]] Investigations typically reveal markedly raised inflammatory markers and evidence of organ dysfunction. Cardiac involvement with reduced left ventricular ejection fraction is common, with evidence of myocarditis on cardiac MRI.[[2,5,6]] Coronary artery aneurysms have been described.[[7]] The CDC diagnostic criteria summarise these features and emphasise the importance of excluding other infectious and inflammatory diagnoses (Table 3).[[8]] Discussion with a multidisciplinary specialist group is recommended.

Treatment of MIS-A is extrapolated from paediatric experience of MIS-C (multisystem inflammatory syndrome of children), for which treatment with glucocorticoids and/or IVIG is recommended.[[9]] With aggressive treatment including ICU support, the prognosis of MIS-A appears reasonable, with a survival rate of 93%.[[2]]

Importantly, SARS-CoV-2 vaccination is likely to significantly reduce the risk of MIS-C.[[10]] Therefore, New Zealand might experience a lower burden of MIS-A and MIS-C than seen in pre-vaccine cohorts. Nevertheless, it is important that New Zealand clinicians are aware of these potentially life-threatening syndromes, as further cases are possible in the 2–5 weeks following a surge in community COVID-19 transmission (as has occurred in March 2022).[[2,9]]

Summary

Abstract

Multisystem inflammatory syndrome in adults (MIS-A), is a rare post-infectious complication of COVID-19. We describe an illustrative case of MIS-A in an otherwise well, SARS-CoV-2 unvaccinated 25-year-old Tongan man who presented to hospital 30 days after mild COVID-19 illness. We highlight the progression of his illness, including treatment in the Intensive Care Unit (ICU) for cardiogenic shock, and detail temporal evolution of clinical, laboratory and radiographic features of his illness. Clinicians should be alert for possible MIS-A in the weeks after a surge in COVID-19 cases.

Aim

Method

Results

Conclusion

Author Information

Tim Cutfield: Infectious Diseases and General Medicine Consultant, Department of Infectious Diseases, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand(ORCID ID 0000-0002-3995-1984). Yousif Saeed: Cardiology Registrar, Department of Cardiology, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand. Amanda Taylor: Paediatric Infectious Diseases Fellow, Department of Paediatric Infectious Diseases, Starship Children’s Hospital, 2 Park Road, Grafton, Auckland, New Zealand. Tim Askelund: General Medicine Consultant, Department of General Medicine, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand. Rob Bevan: Intensive Care Medicine Consultant, Department of Intensive Care, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand. Niels van Pelt: Cardiology Consultant, Department of Cardiology, Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand.

Acknowledgements

The authors would like to acknowledge the high-quality collaborative care provided for this patient by a multidisciplinary team of healthcare professionals at Middlemore Hospital, including members of the General Medical, Infectious Diseases, Cardiology, Rheumatology, Respiratory, Intensive Care, Physiotherapy and Occupational Health departments.

Correspondence

Dr Tim Cutfield: Department of Infectious Diseases, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand

Correspondence Email

Tim.cutfield@middlemore.co.nz

Competing Interests

Nil.

1) Morris SB, Schwartz NG, Patel P, Abbo L, Beauchamps L, Balan S, et al. Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection - United Kingdom and United States, March-August 2020. MMWR Morb Mortal Wkly Rep. 2020 Oct 9;69(40):1450-6.

2) Patel P, DeCuir J, Abrams J, Campbell AP, Godfred-Cato S, Belay ED. Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults: A Systematic Review. JAMA Netw Open. American Medical Association; 2021 Sep 1;4(9):e2126456-6.

3) Jones I, Bell LCK, Manson JJ, Last A, UCLH COVID Response Team. An adult presentation consistent with PIMS-TS. Lancet Rheumatol [Internet]. 2020 Sep;2(9):e520–1. Available from: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30234-4/fulltext

4) Kunal S, Ish P, Sakthivel P, Malhotra N, Gupta K. The emerging threat of multisystem inflammatory syndrome in adults (MIS-A) in COVID-19: A systematic review. Heart Lung [Internet]. 2022 Mar 14;54:7-18. Available from: https://www.sciencedirect.com/science/article/pii/S0147956322000589#!.

5) Aldeghaither S, Qutob R, Assanangkornchai N, Issa-Chergui B, Tam M, Larotondo R, et al. Clinical and Histopathologic Features of Myocarditis in Multisystem Inflammatory Syndrome (Adult)-Associated COVID-19. Crit Care Explor. 2022 Feb;10(2):e0630.

6) Hékimian G, Kerneis M, Zeitouni M, Cohen-Aubart F, Chommeloux J, Bréchot N, et al. Coronavirus Disease 2019 Acute Myocarditis and Multisystem Inflammatory Syndrome in Adult Intensive and Cardiac Care Units. Chest [Internet]. 2021 Feb;159(2):657-62. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476896/.

7) Diakite S, Bousdira N, Tachon G, Ackermann F, Groh M, Rohmer J. Regression of Coronary Aneurysms With Intravenous Immunoglobulins and Steroids for COVID-19 Adult Multisystem Inflammatory Syndrome. JACC Case Rep [Internet]. 2021 Apr;3(4):581-5. Available from: https://pubmed.ncbi.nlm.nih.gov/33782672/.

8) CDC Prevention Epicenters Program. Multisystem Inflammatory Syndrome in Adults (MIS-A) Case Definition Information for Healthcare Providers. 2020. Accessed March 2022. Available from: https://www.cdc.gov/mis/mis-a/hcp.html.

9) Dionne A, Son MBF, Randolph AG. An Update on Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2. Pediatr Infect Dis J. 2022 Jan 1;41(1):e6-e9.

10) Levy M, Recher M, Hubert H, Javouhey E, Fléchelles O, Leteurtre S, et al. Multisystem Inflammatory Syndrome in Children by COVID-19 Vaccination Status of Adolescents in France. JAMA. American Medical Association; 2022 Jan 18;327(3):281-3.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Multisystem inflammatory syndrome in adults (MIS-A), is a rare post-infectious complication of COVID-19. Clinicians should be alert for possible MIS-A in the weeks after a surge in COVID-19 cases.

Case report

A 25-year-old, otherwise well, SARS-CoV-2 unvaccinated Tongan male presented to hospital in November 2021 with one day of fever, painful swollen toes, an itchy rash and diarrhoea. He had recently recovered from uncomplicated, confirmed COVID-19 (symptom onset 30 days prior) and had a resolving dry cough. On initial assessment, he was febrile (38.6°C), tachycardic (128bpm), tachypnoiec (26/min), normotensive (119/74mmHg) and had normal oxygen saturation (97% on air). He had an urticarial rash in his left axilla, diffuse erythema and swelling of the dorsal left foot and toes, and dactylitis of the left third finger. The examination was otherwise unremarkable. Initial investigations included a CRP of 98mg/L, neutrophilia of 9.5x10[[9]]/L, abnormal liver function tests, negative nasopharyngeal SARS-CoV-2 PCR and normal chest X-ray (see Table 2).

Over 48 hours his dactylitis and rash resolved; however, his fevers and inflammatory markers worsened. Further investigations were requested (Table 2) and empiric antibiotics initiated (Table 1). Infectious disease consultation identified conjunctival injection and cracked lips, concerning for possible MIS-A. Initial transthoracic echocardiogram (TTE) was normal. Rheumatology, cardiology and respiratory reviews supported probable MIS-A.

He started treatment with oral prednisone. This was associated with a temporary reduction in inflammatory response, before fever relapsed with tachycardia (130bpm), tachypnoea (30/min) and rising inflammatory and cardiac biomarkers (Tables 1 & 2). He was treated with intravenous immunoglobulin (IVIG), IV methylprednisone, IV ceftriaxone with IV clindamycin (for possible sepsis and toxic shock syndrome) and aspirin (due to reports of MIS-A-associated coronary artery aneurysm). Despite treatment he continued to deteriorate and on day 6 of illness developed cardiogenic shock with pulmonary oedema, requiring mechanical ventilation and inotropic support. A second TTE demonstrated acute severe biventricular dysfunction.

In association with continued glucocorticoid therapy, he recovered over the ensuing 10 days. Evaluation for alternative diagnoses was unrevealing (Table 2). Cardiac MRI on day 17 of illness showed normalised left ventricular function, with changes suggestive of acute myocarditis. CT coronary angiography did not demonstrate coronary artery aneurysm. He was discharged with a reducing dose of prednisone (10mg/week for 4 weeks) and remained well at follow-up two months later.

View Tables 1–3.

Discussion

This illustrative case of MIS-A is the first described in New Zealand. MIS-A is a rare, post-infectious complication of COVID-19.[[1,2]] Diagnosing MIS-A can be challenging, as the preceding COVID-19 illness may be mild or asymptomatic, and symptoms at presentation are non-specific (including fever, rash and gastrointestinal symptoms).[[3,4]] Investigations typically reveal markedly raised inflammatory markers and evidence of organ dysfunction. Cardiac involvement with reduced left ventricular ejection fraction is common, with evidence of myocarditis on cardiac MRI.[[2,5,6]] Coronary artery aneurysms have been described.[[7]] The CDC diagnostic criteria summarise these features and emphasise the importance of excluding other infectious and inflammatory diagnoses (Table 3).[[8]] Discussion with a multidisciplinary specialist group is recommended.

Treatment of MIS-A is extrapolated from paediatric experience of MIS-C (multisystem inflammatory syndrome of children), for which treatment with glucocorticoids and/or IVIG is recommended.[[9]] With aggressive treatment including ICU support, the prognosis of MIS-A appears reasonable, with a survival rate of 93%.[[2]]

Importantly, SARS-CoV-2 vaccination is likely to significantly reduce the risk of MIS-C.[[10]] Therefore, New Zealand might experience a lower burden of MIS-A and MIS-C than seen in pre-vaccine cohorts. Nevertheless, it is important that New Zealand clinicians are aware of these potentially life-threatening syndromes, as further cases are possible in the 2–5 weeks following a surge in community COVID-19 transmission (as has occurred in March 2022).[[2,9]]

Summary

Abstract

Multisystem inflammatory syndrome in adults (MIS-A), is a rare post-infectious complication of COVID-19. We describe an illustrative case of MIS-A in an otherwise well, SARS-CoV-2 unvaccinated 25-year-old Tongan man who presented to hospital 30 days after mild COVID-19 illness. We highlight the progression of his illness, including treatment in the Intensive Care Unit (ICU) for cardiogenic shock, and detail temporal evolution of clinical, laboratory and radiographic features of his illness. Clinicians should be alert for possible MIS-A in the weeks after a surge in COVID-19 cases.

Aim

Method

Results

Conclusion

Author Information

Tim Cutfield: Infectious Diseases and General Medicine Consultant, Department of Infectious Diseases, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand(ORCID ID 0000-0002-3995-1984). Yousif Saeed: Cardiology Registrar, Department of Cardiology, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand. Amanda Taylor: Paediatric Infectious Diseases Fellow, Department of Paediatric Infectious Diseases, Starship Children’s Hospital, 2 Park Road, Grafton, Auckland, New Zealand. Tim Askelund: General Medicine Consultant, Department of General Medicine, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand. Rob Bevan: Intensive Care Medicine Consultant, Department of Intensive Care, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand. Niels van Pelt: Cardiology Consultant, Department of Cardiology, Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand.

Acknowledgements

The authors would like to acknowledge the high-quality collaborative care provided for this patient by a multidisciplinary team of healthcare professionals at Middlemore Hospital, including members of the General Medical, Infectious Diseases, Cardiology, Rheumatology, Respiratory, Intensive Care, Physiotherapy and Occupational Health departments.

Correspondence

Dr Tim Cutfield: Department of Infectious Diseases, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland, New Zealand

Correspondence Email

Tim.cutfield@middlemore.co.nz

Competing Interests

Nil.

1) Morris SB, Schwartz NG, Patel P, Abbo L, Beauchamps L, Balan S, et al. Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection - United Kingdom and United States, March-August 2020. MMWR Morb Mortal Wkly Rep. 2020 Oct 9;69(40):1450-6.

2) Patel P, DeCuir J, Abrams J, Campbell AP, Godfred-Cato S, Belay ED. Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults: A Systematic Review. JAMA Netw Open. American Medical Association; 2021 Sep 1;4(9):e2126456-6.

3) Jones I, Bell LCK, Manson JJ, Last A, UCLH COVID Response Team. An adult presentation consistent with PIMS-TS. Lancet Rheumatol [Internet]. 2020 Sep;2(9):e520–1. Available from: https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30234-4/fulltext

4) Kunal S, Ish P, Sakthivel P, Malhotra N, Gupta K. The emerging threat of multisystem inflammatory syndrome in adults (MIS-A) in COVID-19: A systematic review. Heart Lung [Internet]. 2022 Mar 14;54:7-18. Available from: https://www.sciencedirect.com/science/article/pii/S0147956322000589#!.

5) Aldeghaither S, Qutob R, Assanangkornchai N, Issa-Chergui B, Tam M, Larotondo R, et al. Clinical and Histopathologic Features of Myocarditis in Multisystem Inflammatory Syndrome (Adult)-Associated COVID-19. Crit Care Explor. 2022 Feb;10(2):e0630.

6) Hékimian G, Kerneis M, Zeitouni M, Cohen-Aubart F, Chommeloux J, Bréchot N, et al. Coronavirus Disease 2019 Acute Myocarditis and Multisystem Inflammatory Syndrome in Adult Intensive and Cardiac Care Units. Chest [Internet]. 2021 Feb;159(2):657-62. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476896/.

7) Diakite S, Bousdira N, Tachon G, Ackermann F, Groh M, Rohmer J. Regression of Coronary Aneurysms With Intravenous Immunoglobulins and Steroids for COVID-19 Adult Multisystem Inflammatory Syndrome. JACC Case Rep [Internet]. 2021 Apr;3(4):581-5. Available from: https://pubmed.ncbi.nlm.nih.gov/33782672/.

8) CDC Prevention Epicenters Program. Multisystem Inflammatory Syndrome in Adults (MIS-A) Case Definition Information for Healthcare Providers. 2020. Accessed March 2022. Available from: https://www.cdc.gov/mis/mis-a/hcp.html.

9) Dionne A, Son MBF, Randolph AG. An Update on Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2. Pediatr Infect Dis J. 2022 Jan 1;41(1):e6-e9.

10) Levy M, Recher M, Hubert H, Javouhey E, Fléchelles O, Leteurtre S, et al. Multisystem Inflammatory Syndrome in Children by COVID-19 Vaccination Status of Adolescents in France. JAMA. American Medical Association; 2022 Jan 18;327(3):281-3.

Contact diana@nzma.org.nz
for the PDF of this article

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