Multisystem inflammatory syndrome not exclusive to children

New research suggests that an inflammatory complication of COVID-19 may affect adults as well as children. FatCamera/Getty ImagesDoctors mainly diagnose multisystem inflammatory syndrome in children, but it can also occur in older individuals.Health care providers should suspect the syndrome in adults with increased inflammatory symptoms.Although the disease is serious, prompt treatment can prevent serious consequences.

New information is constantly coming in about the after-effects of COVID-19. Reported complications of COVID-19 disease include blood clots, cardiovascular disease, kidney or liver damage, and post-COVID-19 syndrome.

Multisystem inflammatory syndrome is another serious complication seen by health care professionals in some children who test positive for COVID-19.

While health professionals initially saw this rare but potentially serious COVID-19-related disease in younger patients, it has not been shown to be exclusive to children. There is a small number of adults under the age of 50 who have been diagnosed with this inflammatory syndrome.

Infectious disease specialists at the University of Calgary in Alberta recently published a case study in the Canadian Medical Association Journal suggesting that age should not limit the potential diagnosis of multisystem inflammatory syndrome in adults.

Doctors Geneviève Kerkerian and Stephen D. Vaughan, authors of the case, reported that a 60-year-old man had been diagnosed with the inflammatory condition.

The patient, who had tested positive for SARS-CoV-2 four weeks earlier, visited the hospital with a range of symptoms, including mild shortness of breath, severe fatigue, loss of appetite, high fever and a swollen lymph node.

During the examination, his doctors also noted his red eyes, swollen tongue and a red blush on the ends of his toes.

He did not have the more commonly reported symptoms of multisystem inflammatory syndrome, such as stroke, shock or cardiac dysfunction.

The doctors attributed this to the fact that he had had a milder case of COVID-19 or the prompt diagnosis and interventions he received once in the hospital.

Accurately diagnosing the syndrome has proven challenging. “It’s a little tricky to diagnose,” Dr. William Schaffner, Professor of Infectious Diseases at Vanderbilt University Medical Center in Nashville, Tennessee, told Medical News Today. dr. Schaffner was not involved in the investigation.

There is no single diagnostic test that will definitively indicate the presence of the syndrome. Schaffner compared diagnosing the syndrome to putting the puzzle pieces together until the “ah-ha” moment was reached.

Symptoms of multisystem inflammatory syndrome are similar to those of the hyperinflammatory condition known as Kawasaki disease, which also primarily affects young children.

The American College of Rheumatology published a review comparing symptoms between childhood multisystem inflammatory syndrome and Kawasaki disease. Of the children who met the diagnostic criteria for the syndrome, 25-50% also met the requirements for Kawasaki disease.

The male patient from the case study also met criteria for Kawasaki disease. However, his recent contraction of the SARS-CoV-2 infection and age led doctors to look more deeply into the possibility of multisystem inflammatory syndrome. Closer examination revealed an enlarged heart and a swollen lung. For this patient’s doctors, this was the “ah-ha” moment.

“Given the patient’s recent history of SARS-CoV-2 infection, fever without localization of symptoms, oral mucosal changes, cervical lymphadenopathy, conjunctivitis, and lower extremity changes, we suspected an inflammatory post-COVID-19 syndrome Kerkerian and Vaughan wrote.

The patient was treated with aspirin and steroids. After 24 hours, he began to show signs of reduced inflammation in the eyes, tongue and toes. His doctors discharged him after 5 days with a repeated electrocardiogram that showed normal.

Although multisystem inflammatory syndrome in children is rare, it is common for pediatricians to be very alert to this condition in patients who test positive for SARS-CoV-2. However, much is unknown about the syndrome in adults.

“It’s critical that those caring for adults — the internists, primary care physicians, specialists, nurses — have a sense of this syndrome so that it can be recognized, diagnosed and treated appropriately,” Schaffner said.

Optimal follow-up for multisystem inflammatory syndrome is currently unknown. However, experts agree that monitoring for coronary dilatation and aneurysm should play an important role.

The authors conclude by noting: “Unlike MIS-C (Multisystem Inflammatory Syndrome in Children), there is currently no requirement to report cases of MIS-A (Multisystem Inflammatory Syndrome in Adults) to provincial or state authorities, but this should be encouraged to facilitate research and improve patient outcomes.”

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