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Multisystem inflammatory syndrome in adults: Characteristics, treatment, and outcomes

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Multisystem Inflammatory Syndrome in Adults After Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection and Coronavirus Disease 2019 (COVID-19) Vaccination

Ermias D. Belay et al.

Summary: From December 14, 2020, to April 30, 2021, 20 patients with MIS-A were reported to CDC. The median age was 35 years, with 65% being male. 80% had a preceding COVID-19-like illness before MIS-A onset. All patients had laboratory evidence of prior SARS-CoV-2 infection.

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Identification and description of patients with multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection using the Premier Healthcare Database

Jennifer DeCuir et al.

Summary: Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe hyperinflammatory illness associated with SARS-CoV-2 infection. Most MIS-A patients present with severe cardiac symptoms and have a significant ICU admission rate and mortality rate.

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An Australian case of multisystem inflammatory syndrome in an adult during the 2021 SARS-CoV-2 Delta outbreak

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Severe multisystem inflammatory syndrome (MIS-C/A) after confirmed SARS-CoV-2 infection: a report of four adult cases

M. Sansone et al.

Summary: This retrospective case series describes four critically ill patients with MIS-C/A and reports their clinical presentation, laboratory and radiological findings, treatment, and outcome. These cases occurred in previously healthy patients with a history of laboratory-confirmed mild SARS-CoV-2 infection. The treatment included intravenous immunoglobulin, interleukin-1-receptor antagonists, and pulse steroids, which resulted in rapid clinical improvement. No severe complications were observed during the three-month follow-up period.

INFECTIOUS DISEASES (2022)

Article Infectious Diseases

Enigma of COVID-19: is multisystem inflammatory syndrome in adults (MIS-A) predictable?

Istemi Serin et al.

Summary: This study aimed to determine the effect of LDH/lymphocyte ratio (LLR) on the development of MIS-A. The results showed that LLR level can predict the development of MIS-A, and LLR above 0.32 can predict the mortality rate of MIS-A patients.

BMC INFECTIOUS DISEASES (2022)

Review Immunology

Multisystem Inflammatory Syndrome in Adults: Case Finding Through Systematic Review of Electronic Medical Records

Michael Melgar et al.

Summary: This study found that multisystem inflammatory syndrome in adults (MIS-A) is a severe complication of SARS-CoV-2 infection, but likely underrecognized. The study identified that MIS-A patients were more likely to be younger than 50 years old and non-Hispanic Black. Most MIS-A patients had underlying medical conditions.

CLINICAL INFECTIOUS DISEASES (2022)

Article Clinical Neurology

New-onset refractory status epilepticus as an early manifestation of multisystem inflammatory syndrome in adults after COVID-19

Omar Nawfal et al.

Summary: Multisystem inflammatory syndrome in adults (MIS-A) is a rare hyperinflammatory complication that occurs a few weeks after mild COVID-19 infection, involving multiple organs but rarely the nervous system. This case report describes a young woman who developed new-onset refractory status epilepticus (NORSE) following a mild COVID-19 infection, meeting the criteria for MIS-A. Prompt clinical recovery was observed after treatment with methylprednisolone and immunoglobulin.

EPILEPSIA (2022)

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Cortical unihemispheric brain edema (CUBE) due to a multi-system inflammatory syndrome in adults (MIS-A)

Boby Varkey Maramattom et al.

EPILEPTIC DISORDERS (2022)

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COVID-19-associated Multi-Inflammatory Syndrome in Adults (MIS-A): look into the eyes!

T. Urbina et al.

INTENSIVE CARE MEDICINE (2022)

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Neurological manifestations in COVID-19 patients and their application in predicting fatal disease: A retrospective cohort study

Tian-Shuo Zhao et al.

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Multisystem inflammatory syndrome in an adult with severe hypoxaemia and thyroiditis responsive to corticosteroid and interleukin 6 inhibitor treatment

Thitirat Rojnukoolwanich et al.

Summary: Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe consequence of COVID-19 infection. Adult patients are more likely to present with hypotension and cardiac illness compared to children. The exact prevalence and pathophysiology of MIS-A remain unclear. Treatment is mainly based on case reports with no established guidelines.

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Expanding the spectrum of the hyperferritinemic syndrome, from pathogenic mechanisms to clinical observations, and therapeutic implications

Piero Ruscitti et al.

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The emerging threat of multisystem inflammatory syndrome in adults (MIS-A) in COVID-19: A systematic review

Shekhar Kunal et al.

Summary: MIS-A is a newly identified disease, predominantly affecting males with common symptoms of fever and skin rash. Cardiovascular system involvement is frequent, and treatment typically includes steroids and immunoglobulins. The average hospital stay is 11.67 days with a mortality rate of 5.1% during hospitalization.

HEART & LUNG (2022)

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An unusual presentation of recurrent COVID-19 associated systemic capillary leak syndrome in a patient with multi-system inflammatory syndrome in adults (MIS-A) due to prior COVID-19 infection: Case report and literature review

Shifa Younus et al.

Summary: This report presents a case of a 38-year-old Asian male who initially presented with multisystem inflammatory syndrome in adults (MIS-A) following COVID-19 infection, and later developed new-onset systemic capillary leak syndrome (SCLS). Despite resuscitative measures, the patient passed away. This case highlights the importance of COVID-19 awareness in less educated and underserved areas, as well as the need to raise awareness about rare and fatal manifestations.

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Severe myopathy complicating multisystem inflammatory syndrome in adults (MIS-A) in a young man

Alessandro E. Costa et al.

Summary: We report a case of a young male patient presenting with high fever, cervical lymphadenopathy, maculopapular rash, and elevated inflammatory markers. Further evaluations revealed cardiomyopathy and renal failure. During hospitalization, he developed severe generalized muscle weakness caused by diffuse myopathy without elevated creatine kinase. Eventually diagnosed with multisystem inflammatory syndrome in adults (MIS-A), the patient responded well to treatment with intravenous immunoglobulins and high-dose corticosteroids.

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SARS-CoV-2-related Multisystem Inflammatory Syndrome in Adult complicated by myocarditis and cardiogenic shock

M. A. J. De Smet et al.

Summary: Multisystem Inflammatory Syndrome in Adult (MIS-A) is a rare complication of COVID-19 that involves multiple organ systems. This case report describes the clinical presentation, diagnostic testing, and treatment of a male patient with MIS-A. The patient showed improvement in inflammation and cardiac dysfunction following treatment with pulse corticosteroids and intravenous immunoglobulins.

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Severe Multisystem Inflammatory Symptoms in 2 Adults after Short Interval between COVID-19 and Subsequent Vaccination

Elizabeth R. Jenny-Avital et al.

Summary: This study observed the occurrence of multisystem inflammatory syndrome in 2 older adults in the United States who received mRNA coronavirus vaccine soon after natural infection. 5 similar cases were identified from the Vaccine Adverse Events Reporting System. The timing of vaccination after natural infection may have an adverse effect on the development of vaccine-related systemic inflammatory disorders.

EMERGING INFECTIOUS DISEASES (2022)

Letter Immunology

Multisystem Inflammatory Syndrome in Adult after First Dose of mRNA Vaccine

Yusuke Miyazato et al.

Summary: A 32-year-old man in Japan developed respiratory failure after receiving the first dose of COVID-19 vaccine, leading to a diagnosis of multisystem inflammatory syndrome. Serologic test results indicated previous COVID-19 infection.

EMERGING INFECTIOUS DISEASES (2022)

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Postvaccination Multisystem Inflammatory Syndrome in Adult with No Evidence of Prior SARS-CoV-2 Infection

Young Kyun Choi et al.

Summary: A 22-year-old woman in South Korea developed myocarditis, myopathy, pericarditis, and gastroenteritis ten days after receiving the first dose of coronavirus disease vaccine. The diagnosis was multisystem inflammatory syndrome resulting from coronavirus disease vaccination.

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Multisystem inflammatory syndrome in adults in a young male following severe acute respiratory syndrome coronavirus-2 infection: a case report

Christoph C. Kaufmann et al.

Summary: This article reports a case of successfully treated COVID-19-related MIS-A, highlighting the necessity of an interdisciplinary approach for diagnosing and managing this complex multi-organ disease.

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A systematic review of asymptomatic infections with COVID-19

Zhiru Gao et al.

Summary: Since the outbreak of COVID-19 at the end of December 2019, it has caused significant harm and challenges to over 200 countries and regions worldwide. Many patients with COVID-19 are asymptomatic or have only mild symptoms, yet they can still spread the virus, making screening for asymptomatic infections difficult and complicating national prevention and control efforts.

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COVID-19 associated Kawasaki-like multisystem inflammatory disease in an adult

Sabrina Sokolovsky et al.

Summary: This case report describes a 36-year-old woman with a complete phenotype of Kawasaki Disease, who also had a history of COVID-19 infection, resembling the Multisystem Inflammatory Syndrome in Children (MIS-C). The findings suggest that a virulent strain of SARS-CoV-2 may cause a post-infectious inflammatory syndrome similar to Kawasaki Disease in adults, as well as children.

AMERICAN JOURNAL OF EMERGENCY MEDICINE (2021)

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Anosmia and olfactory tract neuropathy in a case of COVID-19

Chia-Wen Li et al.

Summary: COVID-19 patients can present with symptoms such as anosmia, with relevant radiological findings on brain magnetic resonance imaging.

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Case Report: Lymphohistiocytic Myocarditis With Severe Cardiogenic Shock Requiring Mechanical Cardiocirculatory Support in Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection

Xavier Bemtgen et al.

Summary: Multisystem Inflammatory Syndrome (MIS) is a novel hyperinflammatory syndrome associated with SARS-CoV-2 infection, predominantly affecting children and rarely seen in adults. Immunosuppressive treatment is highly effective for recovery in patients, and a previous mildly symptomatic or asymptomatic SARS-CoV-2 infection may lead to the syndrome.

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The roles of nausea and vomiting in COVID-19: did we miss something?

Tongyue Zhang et al.

Summary: In addition to respiratory symptoms, some COVID-19 patients also experience gastrointestinal symptoms, with nausea/vomiting often being overlooked. The virus can not only attack the lungs but also the gastrointestinal tract. Raising awareness of these symptoms and intervening in a timely manner are crucial in combating COVID-19.

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Nobuhiro Asai et al.

Summary: Observations of clinical manifestations and radiological findings in cases of COVID-19 pneumonia revealed common symptoms of fever and cough, as well as chest CT scans showing ground glass opacities, peripheral distribution, and bilateral lung involvement. Early diagnosis and therapeutic intervention with chest CT scans are crucial for a favorable outcome and prevention of secondary nosocomial transmitted infections.

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Successful treatment of tocilizumab and ivermectin for a patient with ARDS due to COVID-19

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SARS-CoV-2-Related Subacute Thyroiditis, Myocarditis, and Hepatitis After Full Resolution of COVID-19 Serum Markers

Alejandra Osorio Martinez et al.

Summary: A 64-year-old male patient developed myocarditis, subacute thyroiditis, and reactive hepatitis after COVID-19 infection, indicating that COVID-19 is a multisystemic inflammatory disorder. Close follow-up and relevant testing are recommended even after apparent clinical resolution.

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Kawasaki-like multisystem inflammatory syndrome associated with SARS-CoV-2 infection in an adult

Eamonn Faller et al.

Summary: This case report describes a 23-year-old man with Kawasaki-like hyperinflammatory syndrome, suggesting that this condition may not be limited to paediatric patients. The patient presented with symptoms such as vomiting, diarrhea, respiratory distress, and conjunctivitis, and recovered well with treatment.

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Multisystem inflammatory syndrome in an adult following the SARS-CoV-2 vaccine (MIS-V)

Arvind Nune et al.

Summary: A 44-year-old woman presented with adverse events including left upper arm pain, fever, diarrhea, and abdominal pain after receiving the Pfizer-BioNTech mRNA vaccine. She developed a pulmonary embolism and acute kidney injury, but her symptoms resolved after treatment with intravenous methylprednisolone. This case highlights the first reported case of MIS-V following SARS-CoV-2 vaccine administration.

BMJ CASE REPORTS (2021)

Article Medicine, General & Internal

First Cases of Multisystem Inflammatory Syndrome following SARS-CoV-2 infection in Adults in Germany

Karl Rieper et al.

Summary: Multisystem Inflammatory Syndrome is a rare condition that can affect multiple organs, presenting with a variety of symptoms. With the ongoing SARS-CoV-2 pandemic, an increasing number of cases in adults can be expected. Early consideration of Multisystem Inflammatory Syndrome in therapy, including corticosteroids, aspirin, and immunoglobulins, may be more effective in managing the condition.

DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT (2021)

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Atakan Tanacan et al.

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CYTOKINE (2021)

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Evidence of SARS-CoV-2-Specific T-Cell-Mediated Myocarditis in a MIS-A Case

Kevin M. Vannella et al.

Summary: This study reports a case of a 26-year-old man who died of acute myocarditis, with findings suggesting that the virus may have caused a multisystem inflammatory syndrome. SARS-CoV-2 RNA was detected in the patient's heart tissue.

FRONTIERS IN IMMUNOLOGY (2021)

Review Medicine, General & Internal

Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults A Systematic Review

Pragna Patel et al.

Summary: This study summarized the descriptive epidemiology and clinical characteristics of multisystem inflammatory syndrome in adults (MIS-A), indicating that MIS-A is a serious hyperinflammatory condition that typically occurs approximately 4 weeks after onset of acute COVID-19, with most patients showing elevated markers of inflammation and a positive SARS-CoV-2 serologic finding.

JAMA NETWORK OPEN (2021)

Article Medicine, General & Internal

Beware of the ambiguous enemy of multisystem inflammatory syndrome in adult (MIS-A) following Covid-19 infection or vaccination

Ahmad Al Bishawi et al.

Summary: Multisystem Inflammatory Syndrome is a rare clinical presentation described during the evolving COVID-19 pandemic, usually presenting as a sepsis-like syndrome leading to secondary multi-organ dysfunction post-COVID-19 infection in both children and adults.

CLINICAL CASE REPORTS (2021)

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Trends in Geographic and Temporal Distribution of US Children With Multisystem Inflammatory Syndrome During the COVID-19 Pandemic

Ermias D. Belay et al.

Summary: This study conducted a cross-sectional analysis of a large cohort of patients with MIS-C in the United States, identifying 2 peaks that followed COVID-19 peaks by 2 to 5 weeks. The geographic and temporal association of MIS-C with the COVID-19 pandemic suggested that MIS-C resulted from delayed immunologic responses to SARS-CoV-2 infection. Clinical manifestations varied by age and presence or absence of preceding COVID-19.

JAMA PEDIATRICS (2021)

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Characteristics Associated With Multisystem Inflammatory Syndrome Among Adults With SARS-CoV-2 Infection

Giovanni E. Davogustto et al.

JAMA NETWORK OPEN (2021)

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Para-aortic lymphadenopathy associated with adult COVID-19 multisystem inflammatory syndrome

Victor Carvalho et al.

Summary: A 21-year-old woman presented at the emergency department with symptoms of dyspnoea, arterial hypotension, and abdominal pain after developing an influenza-like syndrome. Testing confirmed SARS-CoV-2 infection. Treatment included broad-spectrum antibiotics, high-flow nasal cannula, norepinephrine, intravenous immunoglobulin, and pulse corticosteroid therapy with methylprednisolone, leading to a successful recovery and discharge with full resolution of symptoms.

BMJ CASE REPORTS (2021)

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Multisystem inflammatory syndrome in adults: A rare sequela of SARS-CoV-2 infection

Faran Ahmad et al.

Summary: Reports of multisystem inflammatory syndrome in adults (MIS-A) show that patients may only present symptoms weeks after exposure to COVID-19, but clinical recovery can be achieved through aggressive treatment. Management of MIS-A requires further research for treatment modalities and clinical predictors.

INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES (2021)

Review Medicine, General & Internal

Multisystem Inflammatory Syndrome in an Adult after COVID-19 Vaccination: a Case Report and Literature Review

Jung Wan Park et al.

Summary: Increasing number of people vaccinated are experiencing adverse reactions, including a case of multisystem inflammatory syndrome (MIS) after ChAdOx1 COVID-19 vaccination, characterized by low blood pressure, fever, edema, and systemic inflammation. Prompt diagnosis and treatment are crucial in managing MIS post COVID-19 vaccination.

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Data-driven clustering identifies features distinguishing multisystem inflammatory syndrome from acute COVID-19 in children and adolescents

Alon Geva et al.

Summary: Through unsupervised clustering analysis, researchers identified features with a high likelihood of having MIS-C and also identified a group of patients more likely to have acute severe COVID-19 pulmonary disease. The results of the study help refine the diagnosis of MIS-C.

ECLINICALMEDICINE (2021)

Article Medicine, General & Internal

The First Case of Multisystem Inflammatory Syndrome in Adult after COVID-19 in Korea

Hyemin Chung et al.

Summary: Multisystem inflammatory disease in children, similar to Kawasaki disease, can occur after SARS-CoV-2 infection, and similar syndromes have been reported in adults with a decreased incidence. Multisystem inflammatory syndrome in adults (MIS-A) is characterized by shock, heart failure, and gastrointestinal symptoms with elevated inflammatory markers after COVID-19 infection.

JOURNAL OF KOREAN MEDICAL SCIENCE (2021)

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Multisystem Inflammatory Syndrome after SARS-CoV-2 Infection and COVID-19 Vaccination

Mark B. Salzman et al.

Summary: This report discusses 3 cases of patients in California who experienced multisystem inflammatory syndrome (MIS) after receiving vaccination and being infected with SARS-CoV-2. It also mentions 3 cases of adults who were not vaccinated developing MIS during a period when around 7% of the adult population had received at least one vaccine.

EMERGING INFECTIOUS DISEASES (2021)

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges

Chih-Cheng Lai et al.

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Cardiac Endotheliitis and Multisystem Inflammatory Syndrome After COVID-19

Sharon E. Fox et al.

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COVID-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020

Shana Godfred-Cato et al.

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Multisystem Inflammatory Syndrome in US Children and Adolescents

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Elizabeth M. Dufort et al.

NEW ENGLAND JOURNAL OF MEDICINE (2020)

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Case 24-2020: A 44-Year-Old Woman with Chest Pain, Dyspnea, and Shock

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Olfactory disorder in patients infected with SARS-CoV-2

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Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection - United Kingdom and United States, March-August 2020

Sapna Bamrah Morris et al.

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