SHM Converge Scientific Abstract ePoster Gallery-Multi-Inflammatory Syndrome and Covid-19: A Misunderstood Pairing

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This case report describes a rare adult complication of SARS-CoV-2 infection, Multisystem Inflammatory Syndrome in Adults (MIS-A), which can cause widespread inflammation affecting the respiratory, gastrointestinal, renal, cardiovascular, and skin systems. MIS-A is difficult to diagnose because of its varied presentation and can be overlooked, especially during the COVID-19 pandemic. Diagnostic features include a positive COVID test, fever near hospitalization, cardiac involvement or rash/conjunctivitis, and additional findings such as neurologic symptoms, gastrointestinal symptoms, or thrombocytopenia.<br /><br />The report presents a healthy 28-year-old man with a recent COVID-19 diagnosis who developed dyspnea on exertion, transaminitis, leukocytosis, non-ischemic cardiomyopathy, and heart failure with reduced ejection fraction (30–35%). He also had erythematous patches on the axilla, hips, and upper legs. Skin biopsy showed a viral exanthem, suggesting an inflammatory response. Laboratory studies revealed markedly elevated inflammatory and cardiac markers, including ferritin, procalcitonin, D-dimer, troponin, CRP, and liver enzymes. SARS-CoV-2 antibody testing was reactive.<br /><br />During hospitalization, the patient was transferred for concern for COVID-related myocarditis. Cardiology, infectious disease, and dermatology were consulted. MRI showed reduced systolic function in both ventricles and small bilateral pleural effusions. He was treated with antibiotics, started on cardiac medications, and underwent repeat COVID testing, which was positive. His rash improved and he was discharged three days later.<br /><br />The authors emphasize that MIS-A may be underdiagnosed because adult COVID-19 symptoms can mask other inflammatory complications. They call for further research into the mechanism, timing, and long-term effects of MIS-A, as well as its relationship to SARS-CoV-2.

Asset Subtitle

Abhishek Janardan

Meta Tag

Author List Abhishek Janardan, Devesh Kumar, Sarbagya Pandit

Category Clinical Vignettes

Concept Multisystem Inflammatory Syndrome in Adults

Concept COVID-19 Infection

Concept Cardiac Involvement

Concept Fever

Concept Rash

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Abhishek Janardan

Track Adult

Keywords

MIS-A

SARS-CoV-2

COVID-19

myocarditis

heart failure

non-ischemic cardiomyopathy

viral exanthem

inflammation

cardiac involvement

adult complication

Multisystem Inflammatory Syndrome in Adults

COVID-19 Infection

Cardiac Involvement

Fever

Rash