Volume 27, Number 7—July 2021
Dispatch
Multisystem Inflammatory Syndrome after SARS-CoV-2 Infection and COVID-19 Vaccination
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.