Post Covid 19 Adult Multisystem Inflammatory Syndrome (MIS-A). A Case Report

Abstract

Introduction: during the COVID 19 pandemic associated with severe pneumonia in the resolution phase in children, a multisystem inflammatory disease called "Kawasaki like" was described, now called Pediatric Multisystem Syndrome (MIS-C). Similar syndromes have been  described in the adult population together with persistent post-COVID syndrome. This new condition has been called Adult Multisystem Inflammatory Syndrome (MIS-A) and is characterized by shock, heart failure or persistent hypotension, dyspnea on exertion, mild-moderate hypoxemia, gastric symptoms and persistent elevated systemic inflammation markers after severe pneumonia by COVID 19. Case Report: we present the case of a 56-year-old diabetic male patient who, after 4 weeks of treatment for severe pneumonia and clinical improvement, presents again a sudden case of hypotension, tachycardia, chest pain, dyspnea at rest, severe desaturation and persistent elevated inflammation markers (C-reactive protein, ESR, D-dimer and ferritin). Chest tomography with pneumonia with the presence of bilateral consolidations and generalized ground glass. Echocardiogram with diastolic dysfunction, myopericarditis and secondary endocarditis. MIS-A was diagnosed and treated with IV Immunoglobulin and steroid with favorable response to treatment. Conclusion: this case demonstrates the presence of systemic inflammatory syndrome in adults (MIS-A) as a differential diagnosis in a patient in a persistent post-COVID state. Immunoglobulin and steroids are an alternative treatment to reduce the persistent or uncontrolled inflammatory response.