Director, Department of Internal Medicine; Corresponding Author.
DNB Resident, Department of Internal Medicine, Fortis Escorts Hospital, Jaipur, Rajasthan.
J Assoc Physicians India. 2023 Aug;71(8):11-12. doi: 10.59556/japi.71.0314.
Multisystem inflammatory syndrome-adults (MIS-A) occur in the postacute coronavirus disease 2019 (COVID-19) period with a diverse clinical presentation. A high index of suspicion, early recognition, diagnosis, and treatment of MIS-A might alleviate COVID-19-related morbidity and mortality.
To report seven cases of MIS-A with evidence of recent COVID-19 infection. This is a case series-based study and presents bona fide experiences in terms of main findings and treatment options.
It is a retrospective observational study. We retrospectively collected data on all patients who were diagnosed and treated for MIS-A during the period after the second wave of COVID-19 in India, that is, from June 2021 to November 2021and who were hospitalized in the author's unit. All patients fulfilled the morbidity and mortality weekly report (MMWR) criteria for multisystem inflammatory syndrome in adults. The presenting symptoms, clinical and laboratory parameters, management, and outcome of these seen cases are discussed in this case series-based review..
Data from seven patients were analyzed. Six of them were male, and one patient was female. The median age was 65 years. Four patients had a history of vaccination for COVID-19, three had a history of COVID-19 symptomatic infection in the past, and one patient had contact with COVID-19 in the previous 12 weeks. None of them tested positive for COVID-19 real-time reverse transcription polymerase chain reaction (RT-PCR) test, and all had positive COVID-19 serology. The commonest extrapulmonary organ involved were the cardiovascular and renal systems, followed by the gastrointestinal and central nervous systems (CNS). All had evidence of hyperinflammation. Intravenous immunoglobulin (IVIg) was used in four patients, and steroids were used in all seven patients. The median length of stay (LOS) was 11 days. One patient succumbed to multiorgan failure.
Multisystem inflammatory syndrome (MIS) can affect children (MIS-C) as well as adults (MIS-A). MIS-A is a serious, life-threatening, hyperinflammatory febrile syndrome associated with recent COVID-19 infection and involves multiple organs like the heart, lungs, kidneys, brain, gastrointestinal organs, skin, eyes etc. Clinical suspicion and testing for evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are needed to identify and treat adults suspected to have MIS-A. This case series demonstrates that even the elderly population can be affected and that administration of IVIg and steroids are effective options in management in addition to the usual "standard of care" treatment. Early recognition and prompt treatment of MIS-A could improve clinical outcomes and reduce the mortality rate.
成人多系统炎症综合征（MIS-A）发生在新冠病毒疾病 2019 （COVID-19）后急性期，临床表现多样。提高对 MIS-A 的高度怀疑、早期识别、诊断和治疗意识，可能会减轻 COVID-19 相关的发病率和死亡率。
报告 7 例有近期 COVID-19 感染证据的 MIS-A 病例。这是一项基于病例系列的研究，提供了真实的主要发现和治疗选择经验。
这是一项回顾性观察性研究。我们回顾性地收集了 2021 年 6 月至 2021 年 11 月印度第二波 COVID-19 后期间在作者单位诊断和治疗的所有 MIS-A 患者的数据。所有患者均符合成人多系统炎症综合征的发病率和死亡率周报（MMWR）标准。本病例系列回顾性讨论了这些病例的首发症状、临床和实验室参数、治疗和结局。
分析了 7 例患者的数据。其中 6 例为男性，1 例为女性。中位年龄为 65 岁。4 例有 COVID-19 疫苗接种史，3 例有过去 COVID-19 症状感染史，1 例在过去 12 周内与 COVID-19 有接触。他们均未通过 COVID-19 实时逆转录聚合酶链反应（RT-PCR）检测呈阳性，且均有 COVID-19 血清学阳性。最常见的肺外受累器官是心血管和肾脏系统，其次是胃肠道和中枢神经系统（CNS）。所有患者均有明显的炎症反应。4 例患者使用了静脉注射免疫球蛋白（IVIg），7 例患者均使用了类固醇。中位住院时间（LOS）为 11 天。1 例患者死于多器官衰竭。
多系统炎症综合征（MIS）可影响儿童（MIS-C）和成人（MIS-A）。MIS-A 是一种严重的、危及生命的、与近期 COVID-19 感染相关的高炎症性发热综合征，涉及心脏、肺、肾、脑、胃肠道器官、皮肤、眼睛等多个器官。需要临床怀疑和检测严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的证据，以识别和治疗疑似患有 MIS-A 的成年人。本病例系列表明，即使是老年人群也可能受到影响，除了通常的“标准治疗”外，IVIg 和类固醇的给药也是有效的治疗选择。早期识别和及时治疗 MIS-A 可以改善临床结局，降低死亡率。
