1 Department of Infectious Diseases, Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden
2 Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden
3 Department of Pediatrics, Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg Sweden
4 Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
Bakgrund: Multisystem inflammatory syndrome (MIS) triggered by a recent SARS-Cov-2 infection has been recognized worldwide. Although predominantly affecting children (MIS-C), similar presentations have been reported among adults (MIS-A). Awareness regarding the diagnostic and therapeutic challenges of severe post-COVID-19 hyperinflammation is a key factor in order to prevent morbidity and mortality in this subset of patients.
Metod: A retrospective case series describing four critically ill patients with MIS-C/A diagnosed at Sahlgrenska University Hospital, Gothenburg, Sweden between January and April 2021. Information regarding clinical presentation, laboratory and radiological findings, treatment and outcome is provided.
Resultat: All cases occurred in previously healthy patients with a history of laboratory-confirmed mild SARS-CoV-2 infection within four to seven weeks prior. Median years of age was 24 years (range 19-43) and 3/4 were male. All fulfilled suggested MIS-C/A criteria according to Centre for Disease Control including high fever, laboratory evidence of systemic inflammation and signs of cardiac dysfunction/shock. All cases required care at an intensive care unit (ICU). Treatment was initiated with intravenous immunoglobulin (IVIG), IL-1-receptor antagonist (Kineret) and pulse steroids within five days from admission in 3/4 cases and resulted in rapid clinical improvement. Median length of hospital stay was 13 days (range 12-16). No severe complications were noticed for any of the cases during a three-month follow-up period.
Slutsats: MIS-C/A should be considered, irrespective of age, in patients with fever, hyperinflammation and multiple organ system involvement emerging weeks after COVID-19 infection. Previously suggested treatment regimens for MIS-C seem to be applicable also for MIS-A.