Rare COVID-19-linked syndrome in kids possible in adults too, case report notes

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While research into the specific cause of multisystem inflammatory syndrome in children (MIS-C) is ongoing, a new case report suggests that it may also appear in adults who have a history of COVID-19 diagnosis or exposure. In a case report involving a 60-year-old Canadian man, doctors suggest that age should not limit the potential diagnosis. 

The man, whose case was published in the Canadian Medical Association Journal, sought medical treatment at a hospital for prolonged shortness of breath, high fever, swelling and severe fatigue. His medical history included a positive SARS-CoV-2 diagnosis four weeks prior to the new symptoms, and subsequent testing detected an enlarged heart and lung swelling. He had not received a COVID-19 vaccine and no known comorbidities. 

MIS-C causes different body parts to become inflamed, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs, according to the Centers for Disease Control and Prevention (CDC). The agency has also noted several reports of "a similar multisystem inflammatory syndrome in adults (MIS-A). The authors of the Canadian case report also felt the man’s illness could be described as MIS-A, and said both pediatric and adult rheumatology teams involved in his care agreed that he met the preliminary CDC criteria for MIS-A, and the criteria for Kawasaki disease. 

"Given the patient’s recent history of SARS-CoV-2 infection, fevers without localizing symptoms, oral mucosal changes, cervical lymphadenopathy, conjunctivitis and lower extremity changes, we suspected inflammatory post-COVID-19 syndrome," Drs. Genevieve Kerkerian and Stephen Vaughan, infectious disease specialists in the department of medicine at Cumming School of Medicine, University of Calgary, said in a news release. "The presentation was similar to reported cases of an uncommon but severe complication in children and adolescents infected with SARS-CoV-2, called multisystem inflammatory syndrome in children (MIS-C), as well as to Kawasaki-like illness." 

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Standardized treatment has not been established for MIS-A, but the man was treated with acetylsalicylic acid and methylprednisolone, as well as intravenous immunoglobulin. Within 24 hours his symptoms began to improve substantially and five days after admission he was discharged. At a two-week follow-up, the doctors noted continued improvement, and again six weeks later. 

"In October 2020, the CDC published a review of 27 adult cases that fit the description of a multisystem inflammatory syndrome," the authors wrote, noting that all cases described were in patients younger than 50. 

"As we continue to learn about MIS-A, however, it is prudent not to assume any age limitation when considering the diagnosis, as our case suggests," the authors wrote, adding that "many questions about MIS-A remain unanswered." 

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"Unlike for MIS-C, there is currently no requirement to report cases of MIS-A to provincial or state authorities, but this should be encouraged to facilitate research and improve patient outcomes," they wrote.