Multisystem inflammatory syndrome in adult with features of Kawasaki disease

• Published in: JEADV clinical practice Vol. 3; no. 2; pp. 705 - 709
• Main Authors: Heng, Li Wei, Ong, Geraldine H. M., Lee, Oswald Z. J., Liau, MeiQi May
• Format: Journal Article
• Language: English
• Published: Wiley 01-06-2024
• Subjects: complications; COVID‐19; Kawasaki disease; multisystem inflammatory syndrome in adult
• ISSN: 2768-6566; 2768-6566
• DOI: 10.1002/jvc2.353

We present a case of a 21‐year‐old woman with fever (>38.0°C) for 5 days, mucocutaneous lesions and refractory hypotension requiring dual inotropic support. The only significant past medical history was an episode of COVID infection 4 months before admission. She was diagnosed to have multisystem inflammatory syndrome in adult (MIS‐A)—a relatively new entity which occurs as a severe complication in patients post‐COVID‐19 infection. This condition can present remarkably similarly to Kawasaki disease. Although the paediatric counterpart of MIS‐A typically occurs within 2–6 weeks post COVID‐19 infection, MIS‐A may occur up to 4 months post‐COVID‐19 infection. We wish to raise awareness of this rare entity, their similarities with Kawasaki disease and the importance of early initiation of intravenous immunoglobulin and high‐dose aspirin.
A 21‐year‐old woman presented with fever, rash and refractory hypotension requiring dual inotropic support. Mucocutaneous features include a maculopapular exanthem, “strawberry tongue”, cheilitis, limbal‐sparing conjunctivitis, pustular eruption of the perineum, and erythema and oedema of acral sites with desquamation. Cardiac evaluation revealed acute myocarditis. She was previously well except for an episode of COVID infection 4 months prior. Intravenous immunoglobulin (IVIG), pulsed methylprednisolone and high‐dose aspirin was administered with reversal of cardiac dysfunction and resolution of mucocutaneous findings. The constellation of clinical findings and laboratory evidence fulfills the diagnosis of Multisystem Inflammatory Syndrome in Adult (MIS‐A). We wish to raise awareness of this rare entity, its similarities with Kawasaki disease and the importance of early initiation of treatment.