Thread by @BCMIDFellowship

1/38YOF recovered from mild #COVID19 two weeks ago.

Last week, she developed new fevers, headache, photophobia, dyspnea, nausea, vomiting, polyarthralgias, lip peeling, conjunctival injection, and the following pruritic rash:

#IDTwitter #IDFellows #MedTwitter

2/She was admitted to the hospital.

Labs were notable for elevation of ESR, CRP, D-dimer, BNP, and LFTs. COVID-19 NAAT was positive.

CT showed hepatosplenomegaly.

What organism likely triggered her disease process?

3/This is a case of Multisystem Inflammatory Syndrome in Adults (MIS-A).

MIS-C was first recognized in children in COVID-19 hotspots in March 2020 (kids >12y, mortality rate 2%). Most return to baseline health.

4/Similar syndrome appeared in adults in June. MMWR recently reported on 27 cases of MIS-A using this case definition:

🔸Hospitalized >21yo
🔸(+) SARS-CoV-2 test now or in past 12wk
🔸Severe extrapulmonary organ dysfx
🔸Lab evidence of inflammation
🔸(-) Severe respiratory dz

5/Like MIS-C, MIS-A seems to have good prognosis ➡️3 deaths reported to date.

This patient was treated with IVIG, aspirin, and prednisone taper with clinical improvement.

The rash on her hands and feet eventually desquamated.

6/️Congrats to @mjventuramd @MannyGuajardoMD @EvaClarkMD et al on this recent publication!

Always a pleasure to work through tough cases with our #rheumtwitter friends!

dx.doi.org/10.1136/annrhe…