Multisystem Inflammatory Syndrome Associated with SARS-CoV-2 Infection in an Adult: A Case Report from the Maldives

• Published in: Tropical medicine and infectious disease Vol. 6; no. 4; p. 187
• Main Authors: Miqdhaadh, Ahmed, Imad, Hisham Ahmed, Fazeena, Aminath, Ngamprasertchai, Thundon, Nguitragool, Wang, Nakayama, Emi E, Shioda, Tatsuo
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 19.10.2021; MDPI
• Subjects: Abdomen; Adults; Antibodies; Asymptomatic; Biomarkers; Cardiomyopathy; Cardiovascular system; Case Report; Case reports; clinical manifestations; Coronaviruses; COVID-19; Cytokines; Edema; Heart; Illnesses; Immunology; Infections; Inflammatory diseases; Laboratories; Maldives; Multiple organ dysfunction syndrome; multisystem inflammatory syndrome; Myocarditis; Pathogenesis; Severe acute respiratory syndrome coronavirus 2; Tropical diseases; Maldives; COVID-19; Maldives; multisystem inflammatory syndrome; clinical manifestations; adults
• ISSN: 2414-6366; 2414-6366
• DOI: 10.3390/tropicalmed6040187

The multisystem inflammatory syndrome in adults (MIS-A) is a novel syndrome observed during COVID-19 outbreaks. This hyper-inflammatory syndrome is seen predominantly in children and adolescents. The case of an adult from the Maldives who had asymptomatic SARS-CoV-2 infection three weeks before presenting to the hospital with fever, rash, and shock is presented. De-identified clinical data were retrospectively collected to summarize the clinical progression and treatment during hospitalization and the six-month follow-up. SARS-CoV-2 infection was confirmed by RT-PCR. Other laboratory findings included anemia (hemoglobin: 9.8 g/dL), leukocytosis (leukocytes: 20,900/µL), neutrophilia (neutrophils: 18,580/µL) and lymphopenia (lymphocytes: 5067/µL), and elevated inflammatory markers, including C-reactive protein (34.8 mg/dL) and ferritin (2716.0 ng/dL). The electrocardiogram had low-voltage complexes, and the echocardiogram showed hypokinesia, ventricular dysfunction, and a pericardial effusion suggestive of myocardial dysfunction compromising hemodynamics and causing circulatory shock. These findings fulfilled the diagnostic criteria of MIS-A. The case was managed in the intensive care unit and required non-invasive positive pressure ventilation, inotropes, and steroids. With the new surges of COVID-19 cases, more cases of MIS-A that require the management of organ failure and long-term follow-up to recovery are anticipated. Clinicians should therefore be vigilant in identifying cases of MIS-A during the pandemic.