Title : Multisystem inflammatory syndrome (mis-a) in a filipino adult
Multisystem Inflammatory Syndrome (MIS) is a rare form of COVID-19 affecting multiple extrapulmonary organ systems without severe respiratory illness. It is primarily seen in children under 21 years of age but with similar but rare syndrome in adults that may require intensive care. Up to date, there are no previously reported case of Multisystem Inflammatory Syndrome in Adults (MIS-A) in the Philippines.
A case of a 32 years old male, smoker, no other known comorbidities, with good functional capacity, presented with 9 days history of intermittent fever, body malaise, sore throat, stiff neck, and eye redness followed by appearance of rashes on palms, trunk, and knees with episodes of hallucinations, disorientation, and weakness of lower extremities. During the course of admission, pertinent laboratory findings include leukocytosis, elevated cardiac enzymes with ECG and echocardiogram changes, multiple electrolyte imbalances, acute kidney injury, and reactive arthritis. MIS-A secondary to COVID-19 was suspected due to previous SARS-CoV-2 infection (IgG antibody positive, RT-PCR negative), dysfunction of multiple extrapulmonary organ systems (neurologic dysfunction, cardiac dysfunction, renal dysfunction, acute liver injury, mucocutaneous manifestations), elevated inflammatory markers, and absence of severe respiratory illness. He improved following IV Ceftriaxone, IV Dexamethasone, Tocilizumab, Aspirin, Sulodexide, and supportive care. He was discharged improved on the 8th hospital day.
MIS-A should be considered in adults presenting with compatible clinical findings with concern for COVID-19. Further research is needed among the adult population to understand the pathogenesis, characterize the full range of clinical manifestations, and identify long-term effects of this condition for targeted treatment of the inflammatory process. Ultimately, the prevention of spread of SARS-CoV-2 would limit the occurrence of MIS-A.
Audience take away:
1. To present a case of a 32/M with presenting with signs and symptoms similar to Multisystem Inflammatory Syndrome in Children (MIS-C)
2. To know the global and local epidemiology of Multisystem Inflammatory Syndrome in Adults (MIS-A)
3. To discuss the approach to the diagnostic criteria, pathogenesis, management and complications of MIS-A
4. Clinical recognition of this disease entity is important when caring for adult patients with findings consistent with the working MIS-A case definition to be able to initiate proper treatment and prevent fatal outcomes since these patients may usually require intensive care 5. Understanding and recognizing this disease entity reinforces the need to observe preventive measures to limit the spread of SARS-CoV-2 infection; thus, limiting the occurrence of MIS-A.