Citation Information :
Madhusudan R, Anand B, Sreedhara N, Nidhi M, Girijapathi M, Zachariah J, Sunny N. Management of SARS-CoV-2 Multisystem Inflammatory Syndrome in Adult with Intravenous Immunoglobulin. J Postgrad Med Edu Res 2023; 57 (1):32-34.
Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to evolve creating management dilemmas as time passes. Multisystem inflammatory syndrome in adults (MIS-A) unlike multisystem inflammatory syndrome in children and adolescents (MIS-C) has not been well characterized. Multisystem inflammatory syndrome in adults is a rare but potentially life-threatening hyperinflammatory syndrome affecting adults of all ages. Multisystem inflammatory syndrome in adults can occur in current or previous SARS-CoV-2 infection. Here we present a case of an elderly male with previous SARS-CoV-2 infection who had an unusual presentation with high fever, neck swelling, and skin rashes and recovered after intravenous immunoglobulin (IVIG) therapy. Clinicians should be aware of this postinfectious multisystem inflammatory illness after COVID-19. Intravenous immunoglobulin has an important role to play in the management of MIS-A.
Royal College of Paediatrics and Child Health. Guidance: Paediatric Multisystem Inflammatory Syndrome Temporally Associated with COVID-19. Available from: https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf
Morris SB, Schwartz NG, Patel P, et al. Case series of multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection—United Kingdom and United States, March-August 2020. MMWR Morb Mortal Wkly Rep 2020;69(40):1450–1456. DOI: 10.15585/mmwr.mm6940e1
Multisystem Inflammatory Syndrome in Adults (MIS-A) Case Definition Information for Healthcare Providers. Available from: https://www.cdc.gov/mis/mis-a/hcp.html
Davogustto GE, Clark CE, Hardison E, et al. Characteristics associated with multisystem inflammatory syndrome among adults with SARS-CoV-2 infection. JAMA Netw Open 2021;4(5):e2110323. DOI: 10.1001/jamanetworkopen.2021.10323
Lima R, Filho CC, Filho CMF, et al. Hemophagocytic syndrome and COVID-19, respiratory medicine. Case reports 2020;31:101162. ISSN: 2213-0071. DOI: 10.1016/j.rmcr.2020.101162
Tujula B, Hämäläinen S, Kokki H, et al. Review of clinical practice guidelines on the use of procalcitonin in infections. Infect Dis (Lond) 2020;52(4):227–234. DOI: 10.1080/23744235.2019.1704860
Hu R, Han C, Pei S, et al. Procalcitonin levels in COVID-19 patients. Int J Antimicrob Agents 2020;56(2):106051. Epub 2020 June 10. DOI: 10.1016/j.ijantimicag.2020.106051
Del Sole F, Farcomeni A, Loffredo L, et al. Features of severe COVID-19: a systematic review and meta-analysis. Eur J Clin Invest 2020;50(10):e13378. DOI: 10.1111/eci.13378
Henderson LA, Canna SW, Friedman KG, et al. American College of Rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19: version 2. Arthritis Rheumatol 2021;73(4):e13–e29. DOI: 10.1002/art.41616
Nimmerjahn F, Ravetch JV. Anti-inflammatory actions of intravenous immunoglobulin. Annu Rev Immunol 2008;26:513–533. DOI: 10.1146/annurev.immunol.26.021607.090232
