473: MULTISYSTEM INFLAMMATORY SYNDROME IN ADULTS (MIS-A) AFTER COVID-19 INFECTION

Abstract

Introduction: Multisystem Inflammatory Syndrome was first described in children (MIS-C) after COVID-19 infection, it is characterized by gastrointestinal symptoms, shock, fevers, elevated inflammatory markers, and systolic dysfunction. A few similar presentations have also been reported in young adults designated as Multisystem Inflammatory Syndrome Adult type (MIS-A). Often, due to multi-organ involvement, extensive testing is undertaken with no yield of a clear etiological factor. We present a case of a 23-year-old male who was admitted into the Critical Care Unit for Encephalopathy with multi-organ dysfunction. Description: A 23-year-old male with a medical history of Williams-Campbell syndrome complicated by severe bronchiectasis and obstructive lung disease requiring 2 liters of oxygen at baseline, presented to the hospital with severe Encephalopathy, notably, he tested positive for COVID-19 one month before presentation with no increase in oxygen requirements until hospital presentation. Vitals were otherwise stable. Initial lab values were significant for an elevated AST of 6,620, ALT of 9,540, Creatinine of 4.71, Troponin-I of 3,913, CRP of 19.2, IL-6 of 22.1, and Ammonia of 171. Further investigative workup, including imaging, did not reveal a clear etiology for his presentation. An Echocardiogram however showed left ventricular dysfunction with an ejection fraction of 41%. Management included: broad-spectrum antibiotics which were discontinued after negative infectious workup, steroids for a suspected exacerbation of his lung condition, lactulose, and CRRT being initiated due to worsening renal function which was attributed to cardiac dysfunction leading to Acute Tubular Necrosis. MIS-A was eventually suspected as a diagnosis of exclusion considering the recent history of COVID-19 infection. Steroids were continued leading to gradual improvement of lab values. Discussion: With COVID-19 continuing to make an impact, it is essential to be cognizant of various presentations and sequela. There have been multiple reports of different kinds of sequela, such is our case of MIS-A for which a long steroid taper is the mainstay of treatment. We want to raise awareness in the medical community of the possible consequences of COVID-19 infection such as MIS-A.