Table 1. Cases of multisystemic inflammatory syndrome in adults after COVID-19 vaccination: review of literature.
| Variables | Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | Our patient |
|---|---|---|---|---|---|---|
| Age/sex | 20/female | 40/male | 18/male | 22/male | 44/female | 67/male |
| Underlying disease | Asthma | Depression, hyperlipidemia | Asthma | None | Asthma | Hypertension, diabetes mellitus |
| Types of COVID-19 vaccine | Inactivated SARS-CoV-2 vaccine | No description | No description | No description | BNT162b2 | ChAdOx1 nCoV-19 vaccine |
| Previous COVID-19 infection history | None | None | None | COVID-19 (12 days before vaccination) | None | None |
| Time to onset of symptoms after vaccination | 15 days | 48 days | 18 days | Few hours later | 2 days | 7 days |
| Symptom | Fever, rash, diarrhea, vomiting, cardiogenic shock, acute renal failure | Fever, malaise, diarrhea, neck pain, headache, lethargy | Fever, abdominal pain, diarrhea, vomiting, headache | Fever, sore throat, abdominal pain, headache, fatigue, conjunctival hemorrhage, generalized erythematous maculopapular rash | Fever, hypotension, Left arm pain with worse on limb movement | Fever, rash, diarrhea, headache, chills, and dizziness |
| Initial vital signs | BP 73/56 mmHg | BP 136/88 mmHg | BP 98/58 mmHg | BP 110/- mmHg | BP 81/38 mmHg | BP 90/60 mmHg |
| HR 130/min | HR 102/min | HR 96/min | HR 140/min | HR 100/min | HR 106/min | |
| RR 20/min | RR 20/min | RR 20/min | RR -/min | RR -/min | RR 20/min | |
| BT 37.4°C | BT 37.3°C | BT 36.6°C | BT 39°C | BT > 38°C | BT 38.9°C | |
| O2 saturation 99% | O2 saturation 97% | O2 saturation 97% | O2 saturation -% | O2 saturation -% | O2 saturation 95% | |
| White blood cell count, /µL | 32,300 | 11,300 | 7,000 | 15,000 | 17,100 | 18,790 |
| Platelet count, /µL | 155,000 | 312,000 | 63,000 | 122,000 | - | 158,000 |
| Creatinine, mg/dL | 2.64 | 1.12 | 1.12 | 1.15 | 1.93 | 1.07 |
| C-reactive protein, mg/L | 378 | 199.4 | 185.5 | 249 | 539 | 247.28 |
| D-dimer, µg FEU/mL | 3.01 | 1.15 | 3.44 | 14 | 2.564 | - |
| Ferritin, ng/mL | 533 | 1,079.7 | 3,002 | 4,357 | Normal | 1,948 |
| Fibrinogen, mg/dL | 801 | 875 | 639 | - | - | - |
| BNP, pg/mL | 1,498 | 672 | 106 | > 8,000 | - | 4,687 |
| LDH, U/L | 251 | 156 | 291 | - | - | 228 |
| AST/ALT, IU/L | 43/28 | 55/83 | 59/58 | 53/81 | - | 15/87 |
| Procalcitonin, ng/mL | 160.92 | 0.01 | 4.41 | 9 | - | 4.42 |
| Imaging | TTE: normal LV, EF 45% → 30–35%, the next day chest radiograph: subtle bibasilar ground glass opacities | TTE: normal LV; EF: 50–55%; CT angiogram: no pulmonary embolism, minimal ground glass opacities | TTE: normal LV size EF 40–45%, right ventricle mildly dilated with normal systolic function; chest radiograph: right pleural effusion; CT abdomen and pelvis: hepatomegaly, splenomegaly, small ascites; pericholecystic fluid; retroperitoneal adenopathy | Chest CT: Negative for pulmonary embolism, bilateral moderate pleural effusion, basal atelectasis | Chest CT: Left chest wall muscle oedema with subcutaneous fat stranding | PET-CT: reactive lymph node (Lt. cervical chain, Lt. Supraclavicular regions, both axillae, mediastinum, portocaval, pericaval, Lt. paraaortic, bilateral external iliac chains, inguinal regions), splenic hyperplasia No other focal inflammatory lesions were observed |
| TTE: severe tricuspid regurgitation, pulmonary hypertension, RAE, RVH, EF 45%, thin pericardial effusion | ||||||
| Treatment | Vasopressors × 3 d, IVIG 100 g, methylprednisolone 1 g/d for 3 days, heparin, broad spectrum antibiotics, remdesivir | Dexamethasone 6 mg/d for 10 days, ceftriaxone, azithromycin, enoxaparin | IVIG 100 g, methylprednisolone 1 g/d for 3 days, anakinra 100 mg/d for 3 days, broad-spectrum antibiotics, aspirin | Dexamethasone 6 mg daily | Methylprednisolone 1 g/day for 3 days | Methyprednisolone 1 mg/kg/day for 5 days, and tapering as a half dose |
| Enoxaparin → Aapixaban 5 mg two times per day for 6 months | ||||||
| Outcome | Survived | Survived | Survived | Survived | Survived | Survived |
COVID-19 = coronavirus disease 2019, SARS-CoV-2 = severe acute respiratory syndrome-coronavirus-2, BP = blood pressure, HR = heart rate, RR = respiratory rate, BT = body temperature, BNP = B-type natriuretic peptide, LDH = lactate dehydrogenase, AST = aspartate transaminase, ALT = alanine aminotransferase, TTE = transthoracic echocardiography, LV = left ventricular, EF = ejection fraction, CT = computed tomography, PET-CT = Positron Emission Tomography-CT, Lt. = left, RAE = right atrial enlargement, RVH = right ventricular hypertrophy, IVIG = intravenous immunoglobulin.