Infectious Disease Specialists Report Two Cases of Multisystem Inflammatory Syndrome Associated with COVID-19

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Infectious disease specialists at the University of Miami Miller School of Medicine have treated several adult patients with multisystem inflammatory syndrome (MIS-A) associated with history of COVID-19 infections. Two of their patients were included in the October 2 Morbidity and Mortality Weekly Report issued by the U.S. Centers for Disease Control and Prevention (CDC).

Laura Beauchamps, M.D., Lillian Abbo, M.D., and Shuba Balan, M.D., were citied as co-authors of the CDC report, “Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection — United Kingdom and United States, March–August 2020.” The report noted that multisystem inflammatory syndrome in children (MIS-C) has been increasing in Europe and the United States. These young patients experience shock, heart problems, abdominal pain, and elevated inflammatory markers.

Since June, clinicians in the U.S. and U.K. have seen a similar syndrome (MIS-A) in adults.

“These 27 patients had cardiovascular, gastrointestinal, dermatologic, and neurologic symptoms without severe respiratory illness,” said the CDC report, noting that most tested negative to SARS-CoV-2, the virus that causes COVID-19, and appeared to have recent infections. Clinical guidelines recommend the use of both antibody and viral testing to assist with diagnosis of adults with similar symptoms, said the report, noting that these patients usually require intensive care in a hospital.

“The two Miami patients had severe multiorgan failure, resembling the inflammatory syndrome in children (MIS-C), which presents after weeks of an acute infection with SARS-CoV-2,” said Dr. Beauchamps, assistant professor of clinical medicine. “We contacted the CDC to discuss our findings and gathered evidence regarding this syndrome in adults.”

CDC-Miller School collaboration

The CDC worked closely with Dr. Abbo, professor of clinical infectious diseases, Dr. Balan, an infectious disease fellow, and Dr. Beauchamps in incorporating the first Miami cases of MIS-A in the report, which included 27 adults with multisystem inflammatory syndrome (MIS-A).

“Our patients experienced symptoms of myocardial infarction, kidney and liver failure and neurologic symptoms including signs of cerebrovascular disease (stroke),” Dr. Beauchamps said. “They also had high biomarkers for inflammation, which might indicate an over-reaction by the body’s immune system to the coronavirus infection.”

The first Miami patient was a 50-year-old African American who was treated with remdesivir and corticosteroids, and then discharged after 17 days in the hospital. The second was a 46-year-old African American with obesity and lower right extremity pain who presented with multiorgan failure, who had a negative polymerase chain reaction test for SARS-CoV-2 but had high antibodies. He was in the critical care unit for 11 days until his death.

“These findings suggest that although we have made progress in the last nine months in the diagnosis and treatment of COVID-19 disease, we still don't know enough about the short- and long-term consequences of the infection,” Dr. Abbo said. “We need to remain humble and respectful of this virus. This is not the common cold, and we can’t let down our guard with this serious disease.”

Dr. Beauchamps added, “We don’t know how individuals will react to a COVID-19 infection. If you start feeling troubling symptoms after having COVID-19, you should see a specialist so that you receive the best possible care.”

Responding to multiple nationwide cases of MIS-A, the CDC has developed criteria to enable doctors to identify and better diagnose this condition.

Raising awareness

“For clinicians, we aim to raise awareness of this post-infectious syndrome,” said Dr. Abbo. “It is important to make a timely diagnosis with a good patient history, physical exam, SARS-CoV-2 antibody testing, to guide appropriate management in consultation with infectious disease specialists.”

The CDC report also noted that all but one of the 27 patients came from minority groups, adding that long-standing health and social inequities have resulted in increased risk for infection and severe outcomes from COVID-19 in communities of color. However, the report cautioned against drawing conclusions because of the small sample size from a limited number of locations.

“Further research is needed to understand the pathogenesis and long-term effects of this newly described condition,” the CDC report stated.