Patients with multisystem inflammatory syndrome in adults (MIS-A) after severe infection with acute respiratory syndrome by coronavirus 2 (SARS-CoV-2) have a heterogeneous clinical presentation, according to a research letter published online on 19 May a JAMA network open.
Giovanni E. Davogustto, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues conducted a single-center study to describe the spectrum of MIS-A presentation after SARS infection -CoV-2. Of the 839 patients admitted with a positive SARS-CoV-2 test result, 156 were classified as at risk for MIS-A, and of these patients, 15 met the MIS-A criteria.
The researchers found that patients with MIS-A were younger than those admitted for acute symptoms of COVD-19 (middle age, 45.1 versus 56.5 years) and were more likely to have evidence of SARS-CoV-2 infection documented by serological testing (60.0 percent versus no patient). Nine of the 15 patients (60.0 percent) with MIS-A had acute symptoms of COVID-19 and 20.0 percent required admission for acute COVID-19 prior to admission to MIS-A. During MIS-A admission, 33.3 percent of patients required intensive care treatment for hemodynamic follow-up, vasopressor support, or noninvasive ventilatory support (three, one, and one patient, respectively). Three patients (20.0 percent) had MIS-A as a clinical diagnosis during admission to MIS-A; 26.7 and 46.6 percent received immunosuppressive and antibiotic therapy, respectively. There were no deaths. An average of four organ systems were involved, the most affected being the gastrointestinal, hematological and renal systems.
“These data suggest that, although uncommon, MIS-A has a more heterogeneous clinical presentation than previously seen and is often underdiagnosed,” the authors write.
One author revealed links to the pharmaceutical industry.
Giovanni E. Davogustto et al, Characteristics associated with multisystem inflammatory syndrome among adults with SARS-CoV-2 infection, JAMA network open (2021). DOI: 10.1001 / jamanetworkopen.2021.10323
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