Table 1.
Clinical features and laboratory results of the patient with MIS-A.
| Age | 26 |
| Sex | Male |
| Ethnicity | Not Hispanic or Latino |
| Race | White |
| BMI | 31.39 |
| Comorbidities | Obesity, generalized anxiety disorder |
| Maximum body temperature | 39.8 °C (103.6 °F) |
| Evidence of clinically severe illness requiring hospitalization, with multisystem (≥2) organ involvement | |
| Cardiac (e.g., shock, elevated troponin, BNP, abnormal echocardiogram, arrhythmia) | Yes |
| Renal (e.g., acute kidney injury or renal failure) | Yes |
| Respiratory (e.g., pneumonia, ARDS, pulmonary embolism) | Yesa |
| Hematological (e.g., elevated D-dimers, thrombophilia, or thrombocytopenia) | Yes |
| Gastrointestinal (e.g., elevated bilirubin, elevated liver enzymes, or diarrhea) | Yes |
| Dermatological (e.g., rash, mucocutaneous lesions) | Yes |
| Neurological (e.g., CVA, aseptic meningitis, encephalopathy) | No |
| No alternative plausible diagnosis | Yes |
| COVID-19 exposure within the 4 weeks prior to the onset of MIS-A symptoms | Yes |
| SARS-COV-2 serology, PCR, and other abnormal laboratory results for current admission (with normal reference range) | |
| RT-PCR | Positive (Ct value: 34.1) |
| SARS-CoV-2 total antibody | Positive |
| Initial and peak WBC (k/ul) | 21.7 and 76.5 (4–12) |
| Initial and peak CRP (mg/l) | 246b (<9.0) |
| Initial and peak creatinine (mg/dl) | 4.66 and 6.79 (0.6–1.3) |
| Initial and peak procalcitonin (ng/ml) | 105.12c (<0.05) |
| Initial and peak LDH (units/L) | 236 and >6000 (84–246) |
| Initial and peak ferritin (ng/ml) | 1657 and >20 000 (22–388) |
| Echocardiogram and cardiac catheterization | |
| Initial | Mild mitral regurgitation; severe global hypokinesis of the left ventricle; LVEF 10–15% |
| Prior to discharge | LVEF 60–65% |
| Coronary artery evaluation | RHC and LHC — no evidence of coronary artery aneurysm, severe cardiomyopathy with cardiogenic shock |
| Imaging studies | |
| Abdominal imaging | CT abdomen/pelvis with contrast: mesenteric lymphadenopathy, bilateral perinephric edema extending to the adrenal glands |
| Chest imaging | Chest X-ray: peribronchial thickening without focal consolidation |
| Management | |
| Supplemental O2 requirements | Yes |
| Mechanical ventilation | Yes |
| ECMO | No |
| Hemodialysis | Yes |
| Vasoactive medications | Norepinephrine, vasopressin, epinephrine, dobutamine |
| Steroids | Yes |
| IVIG | Two doses |
| Immune modulators | Anakinra |
| Antiplatelets | Aspirin |
| Anticoagulation | Heparin drip, rivaroxaban |
| Total length of hospital stay (days) | 24 |
| Number of days admitted in ICU | 21 |
| Outcome | Discharged to the skilled nursing facility |
a
Peribronchial thickening on chest X-ray in the absence of focal consolidation or diffuse multifocal infiltrates on presentation.
b
Initial values were the peak values.
c
Peak values on the initial test.