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4th Edition of World Congress on Infectious Diseases

June 21-22, 2023 | Rome, Italy

June 21 -22, 2023 | Rome, Italy
Infection 2023

Larabe Farrukh

Speaker at World Congress on Infectious Diseases 2023 - Larabe Farrukh
Albany Medical Center, United States
Title : Rapid resolution of post-covid-19 inflammatory syndrome in an adult with targeted inhibition of interleukin-1b


Multisystem Inflammatory Syndrome (MIS) is a severe inflammatory response, that occurs days to weeks following the infection of SARS-CoV2, the virus responsible for COVID -19. Initially known in children and named MIS-C, recently several cases of MIS in adults have been reported to CDC, leading to the recognition of a new disease MIS in adults (MIS-A). The current treatment options include high-dose steroids, IVIG, and immunosuppressive therapy. However, the pharmacologic approach remains limited to case reports and pending official guidelines to treat cases with MIS-A. 

We present a case of an adult patient who had a severe inflammatory state following COVID-19 infection, who was treated with IL-1 antagonist therapy with a successful outcome.

Our patient is a 38-year-old male with a history of asthma, and Type-2 Diabetes Mellitus who presented with fever, dyspnea, productive cough, and myalgias. He was previously admitted for COVID-19 pneumonia and was discharged after treatment completion. Soon after discharge, he started developing high-grade fever and worsening dyspnea.

On presentation, labs revealed significantly elevated inflammatory markers (Table 1), however infectious work-up was negative. Despite the initiation of broad-spectrum antibiotic therapy, he continued to deteriorate. In the light of recent SARS CoV-2 infection, patient was suspected to have post-COVID-19 multisystem inflammatory syndrome in adults (MIS-A) (Table 2). He was started on Interleukin-1B antagonist therapy, Anakinra. This resulted in marked improvement in his clinical symptoms co-relating to an almost 50% decrease in his inflammatory markers within a few days. His dyspnea and mental status improved, strength returned, and myalgias resolved over a course of 1-2 weeks.

Lab findings

Initial labs

After treatment

WBC count (4000-9000/uL)



CRP (<8.0 mg/dL)

187.4 mg/L

6.8 mg/L

ESR (0-15 mm/hr)

122 mm/hr

87 mg/dL

Ferritin (24 - 336 ng/mL)


1772 ng/mL

D-dimer (<0.5 mg/dL)

15.17 mg/L

6.19 mg/dL

Fibrinogen (172-483 mg/dL)

789 mg/dL

428 mg/dL

Pro-calcitonin (<0.5 ng/ml)

6.2 ng/ml

0.82 ng/ml

SARS CoV-2 PCR and IgG



Table 1. Laboratory findings in the presented case

Case Definition of MIS-A

Present in this case

Patient aged ≥21 years hospitalized for ≥24 hours


Exclusion of alternative diagnosis (e.g., bacterial sepsis, exacerbation of a chronic medical condition)


Fever (≥38.0 C) for ≥24 hours prior to hospitalization or within the first THREE days of hospitalization


Clinical Criteria




Primary clinical criteria


Severe cardiac illness (myocarditis, pericarditis, coronary artery dilatation/aneurysm, or new-onset right or left ventricular dysfunction (LVEF<50%), 2nd/3rd degree A-V block, or ventricular tachycardia)


Rash and non-purulent conjunctivitis




Secondary clinical criteria


New-onset neurologic signs and symptoms (encephalopathy, seizures, meningeal signs, or peripheral?neuropathy)


Shock or hypotension not attributable to medical therapy


Abdominal pain, vomiting, or diarrhea


Thrombocytopenia (platelet count <150,000/ microliter)




Laboratory evidence


Elevated levels of at least TWO of the following: C-reactive protein, ferritin, IL-6, erythrocyte sedimentation rate, procalcitonin


A positive SARS-CoV-2 test for current or recent infection by RT-PCR, serology, or antigen detection


Table 2. Centers for Disease Control and Prevention Criteria for Multisystem Inflammatory Syndrome in Adults (MIS-A)

We report a case of post-COVID-19 inflammatory syndrome which displayed robust clinical improvement with anakinra. Interleukin-1B (IL-1B) has been identified as one of the key cytokines mediating the hyper-inflammatory state associated with COVID-19 infection.  Anakinra is a recombinant IL-1B receptor antagonist that has been used as a pharmacotherapeutic option in children with MIS-C, although there is a lack of data demonstrating its efficacy.

Our report describes rapid improvement of post-COVID-19 inflammatory syndrome with anakinra monotherapy in an adult patient. This report serves as evidence of another option to treat post-COVID-19 inflammatory in adults, especially in patients who may have a contraindication or could be intolerant to steroid therapy, such as our patient who had uncontrolled Diabetes Mellitus.

Feldstein LR, Rose EB, Horwitz SM, et al.: Multisystem inflammatory syndrome in US children and adolescents. New England Journal of Medicine. 2020, 23:334-46. 10.1056/NEJMoa2021680

Brown LM, Semler MW, Hansen M, Person AK, Kelly SG: Multisystem inflammatory syndrome in an adult with COVID-19. Infectious Diseases in Clinical Practice (Baltimore, Md. 2021, 29:174. 10.1097/IPC.0000000000000996

Centers for Disease Control and Prevention. Multisystem inflammatory syndrome in adults (MIS-A): case definition.

Cogan E, Foulon P, Cappeliez O, et al.: Multisystem inflammatory syndrome with complete Kawasaki disease features associated with SARS-CoV-2 infection in a young adult. A case report. Frontiers in Medicine. 2020, 14:428. 10.3389/fmed.2020.00428

Cattaneo P, Volpe A, Cardellino CS, et al.: Multisystem inflammatory syndrome in an adult (MIS-A) successfully treated with anakinra and glucocorticoids. Microorganisms. 2021, 28:1393. 10.3390/microorganisms9071393

Aggarwal A, Cohen E, Figueira M, et al.: Multisystem Inflammatory Syndrome in an Adult With COVID-19—A Trial of Anakinra: A Case Report. Infectious Diseases in Clinical Practice (Baltimore, Md. 2021, 29:420.

Keywords: COVID-19, Multisystem Inflammatory Syndrome, Interleukin 1-B, Anakinra



Dr Farrukh is currently working as a resident physician at Albany Medical Center, Albany, New York. She graduated from King Edward Medical University, Pakistan in 2019. She is interested in Rheumatology and has presented her research work in multiple national conferences.