Miqdhaadh Ahmed, Imad Hisham Ahmed, Fazeena Aminath, Ngamprasertchai Thundon, Nguitragool Wang, Nakayama Emi E, Shioda Tatsuo
Department of Medicine, Indira Gandhi Memorial Hospital, Malé 20002, Maldives.
Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
Trop Med Infect Dis. 2021 Oct 19;6(4):187. doi: 10.3390/tropicalmed6040187.
The multisystem inflammatory syndrome in adults (MIS-A) is a novel syndrome observed during COVID-19 outbreaks. This hyper-inflammatory syndrome is seen predominantly in children and adolescents. The case of an adult from the Maldives who had asymptomatic SARS-CoV-2 infection three weeks before presenting to the hospital with fever, rash, and shock is presented. De-identified clinical data were retrospectively collected to summarize the clinical progression and treatment during hospitalization and the six-month follow-up. SARS-CoV-2 infection was confirmed by RT-PCR. Other laboratory findings included anemia (hemoglobin: 9.8 g/dL), leukocytosis (leukocytes: 20,900/µL), neutrophilia (neutrophils: 18,580/µL) and lymphopenia (lymphocytes: 5067/µL), and elevated inflammatory markers, including C-reactive protein (34.8 mg/dL) and ferritin (2716.0 ng/dL). The electrocardiogram had low-voltage complexes, and the echocardiogram showed hypokinesia, ventricular dysfunction, and a pericardial effusion suggestive of myocardial dysfunction compromising hemodynamics and causing circulatory shock. These findings fulfilled the diagnostic criteria of MIS-A. The case was managed in the intensive care unit and required non-invasive positive pressure ventilation, inotropes, and steroids. With the new surges of COVID-19 cases, more cases of MIS-A that require the management of organ failure and long-term follow-up to recovery are anticipated. Clinicians should therefore be vigilant in identifying cases of MIS-A during the pandemic.
成人多系统炎症综合征（MIS-A）是在新冠疫情期间观察到的一种新型综合征。这种高炎症综合征主要见于儿童和青少年。本文介绍了一名来自马尔代夫的成年人病例，该患者在出现发热、皮疹和休克症状前三周曾有无症状的新冠病毒感染。回顾性收集了去识别化的临床数据，以总结住院期间及六个月随访期间的临床进展和治疗情况。通过逆转录聚合酶链反应（RT-PCR）确诊了新冠病毒感染。其他实验室检查结果包括贫血（血红蛋白：9.8 g/dL）、白细胞增多（白细胞：20,900/µL）、中性粒细胞增多（中性粒细胞：18,580/µL）和淋巴细胞减少（淋巴细胞：5067/µL），以及炎症标志物升高，包括C反应蛋白（34.8 mg/dL）和铁蛋白（2716.0 ng/dL）。心电图显示低电压复合波，超声心动图显示运动减弱、心室功能障碍和心包积液，提示心肌功能障碍影响血流动力学并导致循环性休克。这些发现符合MIS-A的诊断标准。该病例在重症监护病房进行治疗，需要无创正压通气、血管活性药物和类固醇治疗。随着新冠病例的新一波激增，预计会出现更多需要处理器官衰竭和长期随访至康复的MIS-A病例。因此，临床医生在疫情期间应警惕识别MIS-A病例。
