Multisystem inflammatory syndrome in adults: A case in a previously healthy adult

Abstract

Abstract A 25‐year‐old previously healthy female presented to the emergency department (ED) with 5 days of rash, fevers, shortness of breath, and generalized weakness. She had presented to another ED 4 days previously and noted that her rash had improved, but her other symptoms were worsening. She had recovered from COVID‐19, confirmed by positive antigen test 5 weeks prior. On ED arrival, she was afebrile and persistently tachycardic to a rate of 120 beats per minute, despite aggressive fluid resuscitation with 3L of IV crystalloid. She was found to have a troponin elevated to 0.06 ng/mL in addition to a d‐dimer elevated to 1.42 mcg/mL FEU. She was admitted to the hospital where she developed hypotension requiring vasopressor support and was admitted to the intensive care unit (ICU). A transthoracic echocardiogram revealed a newly reduced ejection fraction of 31%. She was diagnosed with multisystem inflammatory syndrome in adults (MIS‐A). The patient received intravenous immunoglobulin and methylprednisolone 60 mg Q12 hours while admitted. She was discharged on hospital day 3 with a prednisone taper and is currently doing well at her most recent follow‐up with infectious disease.

Keywords

• Covid 19
• critical care
• emergency medicine
• heart failure
• IVIG
• MIS‐A