Aldeghaither Saud, Qutob Rayan, Assanangkornchai Nawaporn, Issa-Chergui Badia, Tam May, Larotondo Rita, Samoukovic Gordan
Department of Critical Care Medicine, McGill University, Montreal, QC, Canada.
Department of Critical Care Medicine, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia.
Crit Care Explor. 2022 Feb 18;10(2):e0630. doi: 10.1097/CCE.0000000000000630. eCollection 2022 Feb.
Multisystem inflammatory syndrome (MIS) associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is a life-threatening condition first described in children (MIS-C). It is characterized by a hyperinflammatory state that involves the cardiovascular, gastrointestinal, dermatologic, and neurologic systems without severe respiratory system involvement. Myocarditis is one of the cardiovascular presentations of MIS that might be complicated with cardiogenic shock. There are few case reports describing SARS-CoV-2-related MIS in adults (MIS-A).
Three cases of healthy young adults diagnosed with severe acute respiratory syndrome-CoV-2 related (MIS-A). The main presentation was cardiogenic shock secondary to histologically proven myocarditis, which resolved rapidly after initiation of medical therapy including anti-inflammatory and immunosuppressive drugs. All the cases, however, required mechanical circulatory support (MCS) as a bridge to recovery.
It appears reasonable to treat the patient with fulminant myocarditis in SARS-CoV-2-associated MIS-A with high-dose corticosteroid "pulse" therapy in order to suppress the inflammatory response and MCS to correct initial metabolic derangement and reestablish/maintain vital organ perfusion. Addition of IV immunoglobulin and other immunomodulators should be assessed in a case-by-case basis especially considering the associated cost resource allocation.
与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染相关的多系统炎症综合征（MIS）是一种危及生命的疾病，最初在儿童中被描述（MIS-C）。其特征是一种涉及心血管、胃肠道、皮肤和神经系统的高炎症状态，而无严重呼吸系统受累。心肌炎是MIS的心血管表现之一，可能并发心源性休克。很少有病例报告描述成人中的SARS-CoV-2相关MIS（MIS-A）。
3例健康年轻成人被诊断为与严重急性呼吸综合征冠状病毒2相关（MIS-A）。主要表现为经组织学证实的心肌炎继发的心源性休克，在开始包括抗炎和免疫抑制药物在内的药物治疗后迅速缓解。然而，所有病例均需要机械循环支持（MCS）作为恢复的桥梁。
对于SARS-CoV-2相关MIS-A中暴发性心肌炎患者，采用大剂量皮质类固醇“冲击”疗法以抑制炎症反应，并使用MCS纠正初始代谢紊乱并重建/维持重要器官灌注，似乎是合理的。应根据具体情况评估静脉注射免疫球蛋白和其他免疫调节剂的添加，尤其要考虑相关的成本资源分配。
