SHM Converge Scientific Abstract ePoster Gallery-Do Not Miss a Diagnosis of Multisystem Inflammatory Syndrome in Adults

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This case highlights multisystem inflammatory syndrome in adults (MIS-A), a rare but likely underrecognized post-COVID complication. A 52-year-old man with hypertension, prior COVID-19 infection two months earlier, and recent SARS-CoV-2 positivity presented with five days of fever, malaise, vomiting, and diarrhea. He had also recently completed two doses of Moderna vaccine and received a monoclonal antibody infusion.<br /><br />On arrival, he was febrile, tachycardic, hypotensive, and tachypneic. Initial evaluation showed mild bibasilar ground-glass opacities on chest CT, negative blood cultures, positive SARS-CoV-2 IgG, and elevated inflammatory markers. He improved transiently with fluids and steroids, but later developed respiratory distress, orthopnea, elevated troponin and BNP, pulmonary edema, and newly depressed left ventricular ejection fraction on cardiac MRI, consistent with stress-induced cardiomyopathy.<br /><br />MIS-A was emphasized because the patient matched several common features reported in the syndrome: fever, hypotension, cardiac dysfunction, shortness of breath, and diarrhea. MIS-A is characterized by severe illness, evidence of SARS-CoV-2 infection, extrapulmonary organ dysfunction, marked inflammation, and absence of severe respiratory disease. It often occurs about four weeks after infection and may be difficult to distinguish from other adult comorbidities.<br /><br />Recommended workup includes SARS-CoV-2 serology, especially nucleocapsid IgG, inflammatory markers such as ferritin, CRP, and ESR, and evaluation for coagulopathy. Treatment is supportive and may include anticoagulation, corticosteroids, IVIg, and immune modulators such as tocilizumab or anakinra. In this case, the patient received IVIg, dexamethasone, prophylactic heparin, aspirin, and later anakinra, with gradual improvement and discharge on a prednisone taper.

Asset Subtitle

James M. McCluskey III

Meta Tag

Author List Diane Topolski, James M. McCluskey III, Srinivas Vunnam

Category Clinical Vignettes

Concept Multisystem Inflammatory Syndrome in Adults

Concept Fever

Concept Hypotension

Concept Cardiac Dysfunction

Concept Shock

Distinguished Non-Finalist

Presenter Organization University of Nebraska Medical Center

Presenting Author James M. McCluskey III

Track Adult

Keywords

multisystem inflammatory syndrome in adults

MIS-A

COVID-19 complication

SARS-CoV-2 infection

cardiac dysfunction

stress-induced cardiomyopathy

inflammatory markers

intravenous immunoglobulin

corticosteroids

anakinra

Multisystem Inflammatory Syndrome in Adults

Fever

Hypotension

Cardiac Dysfunction

Shock