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 2
Demographic, laboratory, and clinical characteristics of patients who had multisystem inflammatory syndrome without SARS-CoV-2 immunization, California, USA
| Characteristic | Patient 4 | Patient 5 | Patient 6 |
|---|---|---|---|
| Age/sex |
62 y/M |
29 y/F |
23 y/M |
| Race/ethnicity |
Asian |
Hispanic/Latina |
Hispanic/Latino |
| Underlying conditions |
Hyperlipidemia, gout, atrial fibrillation |
Obesity |
Asthma, obesity |
| Signs and symptoms |
6 d of fever, vomiting, abdominal pain, 4 d of hearing loss; shock, acute renal failure |
4 d of fever, headaches, vomiting, abdominal pain; conjunctivitis, shock,
acute kidney injury |
4 d of fever, abdominal pain, diarrhea, cough, SOB; shock |
| Initial vital signs |
Pulse 121 beats/min, BP 112/63 mm Hg, RR 20 breaths/min, temp 101.6°F, O2 sats 98%; within 1 h in ER: BP 70/56 mm Hg, pulse 112 beats/min, RR 28 breaths/ min, O2 sat 97%; BMI: 28.1 |
Pulse 140 beats/min, BP 102/71 mm Hg (61/48 mm Hg after 5 h of being in ER), RR 20, temp 105.2°F, O2
sats 99%; BMI: 31.63 |
Pulse 125 beats/min, BP 87/27 mm Hg, temp 98.2°F, O2 sats 98% on RA;
BMI: 40.3 |
| Treatment |
Vasopressors, methylprednisolone 125 mg every 6 h, broad spectrum antibiotics, enoxaparin |
Vasopressors, methylprednisolone 30 mg every 12 h, IVIG 100 g, heparin, ceftriaxone, ciprofloxacin |
Vasopressors, IVIG 2 g/kg, methylprednisolone 1 g daily for 3 d, broad spectrum antibiotics |
| Imaging |
EKG: diffuse ST elevation; TTE: mild concentric LVH, mild LV systolic dysfunction, EF 50%; CT angiogram: no evidence of embolus; increased interstitial markings and hazy ground glass changes, small bilateral pleural effusions; 6 mm pericardiac effusion; ultrasound:
right popliteal DVT |
TTE: LVEF 50%–55%, mild TR regurgitation, abdominal CT with colitis and enlarged lymph nodes |
EKG: sinus tachycardia, no ST changes; TTE: LVEF 20%, global hypokinesis, abdominal CT with mesenteric adenitis |
| Length of hospital stay |
7 d |
10 d |
12 d; deceased |
| First vaccine |
NA |
NA |
NA |
| Second vaccine |
NA |
NA |
NA |
| Previously known COVID-19 |
23 days before symptom onset |
28 d before symptom onset |
38 d before symptom onset |
| Initial lab results (reference ranges) | |||
| Serum leukocytes, × 1,000/mcL (4.5–14.5) | 18.4 | 10.2 | 6.8 |
| Lymphocytes absolute, × 1,000/mcL (1.5–6.8) | 0.00 | 0.35 | 0.52 |
| Neutrophils absolute, × 1,000/mcL (1.5–8.00) | 17.66 | 9.66 | 14.35 |
| Platelets, × 1,000/mcL (130–400) | 102 | 170 | 185 |
| Creatinine, mg/dL (<1.00) | 2.24 | 0.78 | 2.49 |
| C-reactive protein, mg/L (<7.4) | 351.7 | 364.9 | 246.3 |
| D-dimer, µg FEU/mL (<0.49) | 7.21 | 5.79 | >4 |
| Ferritin, ng/mL (17–168) | 5,032 | 606 | 1,273 at admission, >18,000 at its peak 2 days later |
| Fibrinogen, mg/dL (218–441) | N/A | N/A | 454 |
| Troponin, ng/mL (<0.03) | 0.85 | 0.06 | <0.02 |
| BNP, pg/mL (<99) | 931 | 331 | 228 |
| LDH, U/L (<279) | 267 | N/A | 224 |
| AST, U/L (<34) | 38 | N/A | 42 |
| ALT, U/L (<63) | 40 | 55 8 | 88 |
| Procalcitonin, ng/mL (0.0–0.1) | Not done | 8.15 | 29.37 |
| SARS-COV-2 nucleocapsid IgG qualitative | Not done | Positive | Not done |
| SARS-COV-2 PCR | Positive | Negative | Positive |
| Blood culture | Negative x 2 | Negative x 4 | Negative x 9 |
| Urine culture | Negative (after antibiotics) | Negative (after antibiotics) | Negative (after antibiotics) |
| Bacterial GI PCR panel | Not done | Negative | Not done |
*ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; BNP, brain natriuretic peptide; BP, blood pressure; CT, computed tomography; COVID-19, coronavirus disease; DVT, deep venous thrombosis; 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
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