Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 27, Number 7—July 2021
Dispatch

Multisystem Inflammatory Syndrome after SARS-CoV-2 Infection and COVID-19 Vaccination

Mark B. SalzmanComments to Author , Cheng-Wei Huang, Christopher M. O’Brien, and Rhina D. Castillo
Author affiliations: Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California, USA (M.B. Salzman); Kaiser Permanente Los Angeles Medical Center, Los Angeles (C.-W. Huang); Kaiser Permanente Zion Medical Center, San Diego, California, USA (C.M. O’Brien); Kaiser Permanente Tustin Ranch Medical Offices, Tustin, California, USA (R.D. Castillo)

Main Article

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.

Main Article

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.
file_external