Early recognition could improve treatment of rare COVID-19 disease in adults

Key points to remember:

• Recognizing specific symptoms of MIS-A could help clinicians spot the rare condition, the researchers said.
• Many cases manifest 3 to 12 weeks after infection with SARS-CoV-2.

A study of more than 50 adults with severe inflammatory syndrome linked to SARS-CoV-2 infection found that less than half were diagnosed with the disease while hospitalized.

The study identified features that separate multisystem inflammatory syndrome in adults (MIS-A) from acute COVID-19 during early hospitalization – including, among others, the absence of radiographic findings typical of the COVID-19 pneumonia and “marked elevation” of high neutrophil/low lymphocyte count (NLR) and D-dimer, researchers reported in Clinical infectious diseases.

MIS-A is similar multisystem inflammatory syndrome in children (MIS-C), which was identified early in the pandemic.

The new study also found that adult patients with this relatively rare disease were more likely to have had COVID-19 for 14 days or more, and when hospitalized they more often had gastrointestinal symptoms and chest pain, but fewer underlying medical conditions, according to Michael J Melgar, medical doctor, an internist at NYU-Langone Hospital and CDC COVID-19 researcher, and colleagues.

According to the researchers, patients later diagnosed with MIS-A are also less likely to experience more traditional COVID-19 symptoms like cough and dyspnea.

“The diagnosis of MIS-A is often questioned by the overlap of symptoms and clinical signs with acute COVID-19 in adults,” Melgar and colleagues wrote. “Indeed, less than half of the MIS-A patients in our study cohort were diagnosed during their hospitalization.”

In a retrospective cohort study, researchers analyzed the medical records of 10,223 patients hospitalized for illnesses associated with SARS-CoV-2 between March 1, 2020 and December 31, 2021, identifying 53 people with MIS-A who had were matched to 106 non-MIS-A COVID-19 patients hospitalized with acute symptomatic illness.

The median age of MIS-A patients was 30 years, almost all with severe heart disease (90.6%) and most with gastrointestinal symptoms (81.1%) or shock or hypotension (77.4%).

Most patients with MIS-A and COVID-19 were likely to have an underlying medical condition (72% versus 88%, respectively), but patients with MIS-A were less likely to be obese (42% vs. 60%) and significantly more likely to have received laboratory-confirmed COVID-19 14 or more days prior to hospital admission (26% vs. 3%).

MIS-A patients were also more likely to initially present to the ER with abdominal pain, vomiting, chest pain/pressure/discomfort, diarrhea, and neck pain.

There were 1.24 cases of MIS-A per 1,000 COVID-19 hospitalizations, the frequency of which decreased with each subsequent pandemic wave, the researchers found.

In general, patients with MIS-A had SARS-CoV-2 infection between 3 and 12 weeks before hospital admission.

“MIS-A is a rare complication of SARS-CoV-2 infections and has a more severe presentation and hospital course than COVID-19,” Melgar and colleagues wrote. “Compared to age- and sex-matched COVID-19 patients, MIS-A patients had longer hospital stays, more often underwent multiple imaging studies, and more often required intensive care interventions.”

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