Multisystem Inflammatory Syndrome in an Adult: A Rare Cause of ST-Segment Elevation MI

Abstract

The COVID-19 pandemic is a significant worldwide health emergency. Due to the high incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, there are increasingly recognisable early and long-term outcomes of the disease. One of the uncommon complications of SARS-CoV-2 infection is multisystem inflammatory syndrome in adults (MIS-A). This is a post-sequela of SARS-CoV-2 infection associated with hyperinflammatory syndrome accompanied by extrapulmonary organ dysfunction. The prevalence of MIS-A ranges from 0.2% to 11.7% of the studied SARS-CoV-2 infection cases. The lack of awareness of this condition and unusual constellation of symptoms makes its management challenging. A 36-year-old woman who had a recent SARS-CoV-2 infection presented with chest pain and hypotension. An ECG showed ST-segment elevation in the anteroseptal wall, elevated cardiac enzymes and inflammatory markers. Transthoracic echocardiogram revealed segmental hypokinesia with a mildly reduced ejection fraction of 41%. Coronary angiogram showed normal arteries. A diagnosis of MIS-A was considered and the patient was started on steroids and IV immunoglobulin.