Al Bishawi Ahmad, Ali Maisa, Al-Zubaidi Khaled, Abdelhadi Hamad
Infectious Diseases Division Department of Internal Medicine Communicable Diseases Centre Hamad Medical Corporation Doha Qatar.
Department of Paediatrics Paediatric Infectious Disease Hamad Medical Corporation Doha Qatar.
Clin Case Rep. 2021 Nov 26;9(11):e05138. doi: 10.1002/ccr3.5138. eCollection 2021 Nov.
Multisystem Inflammatory Syndrome is a rare and novel clinical presentation described during the evolving COVID-19 pandemic. The condition is usually presenting as a sepsis-like syndrome leading to secondary multi-organ dysfunction post-COVID-19 infection. Although the syndrome has been mainly described in children, rare adults' form has been similarly described. We are describing a 37-year-old female patient presented with fever and neck pain after 1 month of a mild SARS-CoV-2 infection course and 10 days post her second COVID-19 vaccine. Examination demonstrated fever, hypotension, and hypoxemia, in addition to multiple tender cervical lymph nodes. Initial laboratory workup showed evidence of significant inflammation with raised markers, including C-reactive protein, ferritin, and interleukin-6. Extensive evaluation to rule out active infection was done, and all return negative, including repeat SARS-CoV-2 test. Furthermore, cardiac evaluation showed moderately reduced systolic ventricular function. Despite all negative test and supportive measures, the patient continued to deteriorate requiring critical care admission for ionotropic support, non-invasive ventilation in addition to presumptive broad-spectrum antimicrobial management. There was no significant improvement with supportive care until the presentation of multisystem involvement on in the context of a recent history of COVID 19 and negative infective screen was raised. The diagnosis of multisystem inflammatory syndrome-adult form (MIS-A) was embraced, and the patient was commenced on methylprednisolone leading to a dramatic resolution of symptoms both clinically and biochemically with stabilization of vital functions allowing for safe outcomes.
多系统炎症综合征是在不断演变的新冠疫情期间描述的一种罕见且新颖的临床表现。该病症通常表现为类似脓毒症的综合征，导致新冠病毒感染后出现继发性多器官功能障碍。尽管该综合征主要在儿童中被描述，但也有类似的成人病例报道。我们报告一名37岁女性患者，在轻度新冠病毒感染病程1个月后以及接种第二剂新冠疫苗10天后出现发热和颈部疼痛。检查发现除了多个颈部压痛淋巴结外，还有发热、低血压和低氧血症。初步实验室检查显示有明显炎症迹象，炎症标志物升高，包括C反应蛋白、铁蛋白和白细胞介素-6。进行了广泛评估以排除活动性感染，所有结果均为阴性，包括重复新冠病毒检测。此外，心脏评估显示收缩期心室功能中度降低。尽管所有检查结果均为阴性且采取了支持措施，但患者病情仍持续恶化，需要重症监护病房进行离子支持、无创通气以及经验性广谱抗菌治疗。在新冠病毒感染近期病史背景下出现多系统受累且感染筛查阴性之前，支持治疗并无显著改善。确诊为成人型多系统炎症综合征（MIS-A）后，患者开始使用甲泼尼龙治疗，临床和生化症状均显著缓解，生命体征稳定，预后良好。
