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Case Reports: Rare disease
Multisystem inflammatory syndrome in an adult (MIS-A) due to SARS-CoV-2 infection presenting to a South African hospital
  1. Sarvesh Balkaran1,
  2. Samuel Peres Surdut2,
  3. David Morris Rose2 and
  4. Robert Freercks3
  1. 1Department of Medicine, Walter Sisulu University Faculty of Health Sciences, Gqeberha, South Africa
  2. 2Intensive Care Unit, Livingstone Tertiary Hospital, Gqeberha, South Africa
  3. 3Department of Medicine, Division of Nephrology and Hypertension, University of Cape Town, Gqeberha, South Africa
  1. Correspondence to Dr Robert Freercks; robert.freercks{at}uct.ac.za

Abstract

Kawasaki-like multisystem inflammatory syndrome related to SARS-CoV-2 infection is a well-described condition in children and adolescents (MIS-C) and now also in adults (MIS-A). We report a case of MIS-A in a previously well woman in her mid-30s who presented with vasopressor-dependent shock 2 weeks after initial recovery from suspected SARS-CoV-2 infection, accompanied by fever, vomiting, diarrhoea, weakness, arthralgia, rash, cough and headache. Examination was notable for fever, tachycardia, hypotension, cervical lymphadenopathy, mucocutaneous involvement, neck stiffness, pansystolic murmur and bilateral crepitations. Inflammatory markers were elevated. Echocardiogram showed mitral regurgitation with preserved ejection fraction. She was treated with vasopressors, admitted to the intensive care unit and subsequently required invasive mechanical ventilation. Both PCR and antibodies for SARS-CoV-2 were positive. Treatment with intravenous methylprednisolone and intravenous immunoglobulin was initiated with rapid improvement in clinical condition and inflammatory markers. She has since made a full recovery with normal echocardiogram 8 months later.

  • COVID-19
  • adult intensive care
  • infectious diseases
  • cardiovascular medicine
  • rheumatology

https://doi.org/10.1136/bcr-2021-246587

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    Footnotes

    • Contributors All of the authors were involved in the management and investigations of the case presented. SB was involved in manuscript write-up, literature review and informed consent. SPS and DMR assisted with manuscript review. RF was involved in review and critical appraisal of the manuscript as the senior author.

    • Funding This study was funded by Kidneys, Infectious Diseases and Critical Care (KICC) Public Benefit Organisation (N/A).

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.