Volume 27, Number 7—July 2021
Dispatch
Multisystem Inflammatory Syndrome after SARS-CoV-2 Infection and COVID-19 Vaccination
Mark B. Salzman
, Cheng-Wei Huang, Christopher M. O’Brien, and Rhina D. Castillo
, Cheng-Wei Huang, Christopher M. O’Brien, and Rhina D. Castillo
Table 1
Demographic, laboratory, and clinical characteristics of 3 patients who had multisystem inflammatory syndrome after SARS-CoV-2 immunization, Southern California, USA
| Characteristic | Patient 1 | Patient 2 | Patient 3 |
|---|---|---|---|
| Age, y/sex |
20 y/F |
40 y/M |
18 y/M |
| Race/ethnicity |
Hispanic/Latina |
Hispanic/Latino |
Asian/Filipino |
| Underlying conditions |
Asthma |
Depression, hyperlipidemia |
Asthma |
| Symptoms |
Fever and rash for 3 d, diarrhea, vomiting, cardiogenic shock, acute renal failure |
6 d of fevers, malaise, diarrhea, neck pain, headache, lethargy |
3 d of fever, 2 d of abdominal pain, diarrhea, vomiting and headache |
| Initial vital signs |
Pulse: 130 beats/min, BP 73/56 mm Hg, RR 20 breaths/min, temp 99.4°F, repeat temp 101.4, O2 sats 99% on RA; BMI: 27.85 |
Pulse 102 beats/min, BP 136/88 mm Hg, RR 20 breaths/min, temp 99.2°F, O2 sats 97% on RA; BMI: 28.89 |
Pulse 96 beats/min, BP 98/58 mm Hg, RR 20 breaths/min, temp 97.9°F, sats 97% on RA; BMI: 23.99 |
| Treatment |
Vasopressors × 3 d, IVIG 100 g, methylprednisolone 1 g/d for 3 d, heparin, broad spectrum antibiotics, remdesivir |
Dexamethasone 6 mg/d for 10 d, ceftriaxone, azithromycin, enoxaparin |
IVIG 100 g, methylprednisolone 1 g/d for 3 d, anakinra 100 mg/d for 3 d, broad-spectrum antibiotics, aspirin |
| Imaging |
TTE: normal LV, mildly reduced EF 45% which decreased to 30%–35% the next day; chest radiograph: subtle bibasilar ground glass opacities |
EKG: ST depression and T wave inversion in inferior leads; TTE: normal LV; EF: 50%–55%; CT angiogram: no pulmonary embolism, minimal ground glass opacities |
TTE: normal LV size with mild to moderately reduced EF 40%–45%, right ventricle mildly dilated with normal systolic function; chest radiograph: right pleural effusion; CT abdomen and pelvis: hepatomegaly, splenomegaly, small ascites; pericholecystic fluid; retroperitoneal adenopathy. |
| Length of hospital stay |
8 d |
3 d |
9 d |
| First vaccine |
12 d before symptom onset |
42 d before symptom onset |
19 d before symptom onset |
| Second vaccine |
NA |
4 d before symptom onset |
NA |
| Previously known COVID-19 disease |
No |
34 d before symptom onset |
43 d before symptom onset |
| Initial lab results (reference range) | |||
| Serum leukocytes, × 1,000/mcL (4.5–14.5) | 32.3 | 11.3 | 7 |
| Lymphocytes absolute, × 1,000/mcL (1.5–6.8) | 0.55 | 0.94 | 0.26 |
| Neutrophils absolute, × 1,000/mcL (1.5–8.00) | 31.75 | 12.68 | 6.28 |
| Platelets, × 1,000/mcL (130–400) | 155 | 312 | 63 |
| Creatinine, mg/dL (<1.00) | 2.64 | 1.12 | 1.12 |
| C-reactive protein, mg/L (<7.4) | 378 | 199.4 | 185.5 |
| D-dimer, µg FEU/mL (<0.49) | 3.01 | 1.15 | 3.44 |
| Ferritin, ng/mL (17–168) | 533 | 1,079.7 | 3,002 |
| Fibrinogen, mg/dL (218–441) | 801 | 875 | 693 |
| Troponin, ng/mL (<0.03) | 1.54 | 0.37 | 0.06 |
| BNP, pg/mL (<99) | 1,498 | 672 | 106 |
| LDH, U/L (<279) | 251 | 156 | 291 |
| AST, U/L (<34) | 43 | 55 | 59 |
| ALT, U/L (<63) | 28 | 83 | 58 |
| Procalcitonin, ng/mL (0.0–0.1) | 160.92 | 0.01 | 4.41 |
| SARS-COV-2 nucleocapsid IgG qualitative | Positive | Positive | Positive |
| SARS-COV-2 PCR | Positive | Positive | Negative |
| Blood culture | Negative × 2 | Negative × 2 | Negative × 2 |
| Urine culture | Negative | Not done | Negative (after antibiotics) |
| Bacterial GI PCR panel | Negative | Not done | Negative |
*All patients received the Pfizer-BioNTech vaccine (https://www.pfizer.com). ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; BNP, brain natriuretic peptide; BP, blood pressure; CT, computed tomography; EF, ejection fraction; EKG, electrocardiogram; GI, gastrointestinal; IVIG, intravenous immunoglobulin; LDH, lactate dehydrogenase; LV, left ventricle; MR, mitral regurgitation; NA, not applicable; RA, room air; RR, respiratory rate; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; sats, saturations; temp, temperature; TR, tricuspid regurgitation; TTE, transthoracic echocardiogram.
Page created: May 25, 2021
Page updated: June 17, 2021
Page reviewed: June 17, 2021
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.