11 October 2021: EditorialDinah V. Parums *
Med Sci Monit 2021; 27:e935005
ABSTRACT: Recent studies on the pathogenesis and clinical spectrum of human disease following infection with the new human pathogen, SARS-CoV-2, have identified the varied presentations and sequelae of COVID-19. Acute ‘cytokine storm’ in severe COVID-19 results in multiorgan damage due to vascular hyperpermeability, edema, and hypercoagulation. The long-term consequences of infection from SARS-CoV-2 include long COVID. or post-COVID syndrome, and multisystem inflammatory syndrome in children (MIS-C). Several case reports of multisystem inflammatory syndrome in adults (MIS-A) have shown the presentation at more than four weeks after initial infection with SARS-CoV-2 in adults more than 21 years of age. In September 2021, a published systematic review of the literature identified 221 patients with MIS-A, representing the most comprehensive clinical study to date. MIS-A occurs in the post-acute COVID-19 period. The pathogenesis may involve a dysregulated antibody-mediated immune response, similar to MIS-C. Therefore, patients with MIS-A may respond to supportive therapies that control hyperinflammation. This Editorial aims to describe MIS-A and discuss COVID-19 as a spectrum of hyperinflammatory disease in terms of severity, extent, duration, and patient age.
Keywords: Editorial, Multisystem Inflammatory Disease, Adults, MIS-A, SARS-CoV-2, COVID-19
There remain many questions regarding the presentation, pathogenesis, and outcome of MIS-A. Until more is known about the clinical presentation of MIS-A and its diagnosis, future cases are likely to be unrecognized. Because cases of MIS-A occur in the post-acute COVID-19 period, the pathogenesis may involve a dysregulated antibody-mediated immune response, similar to MIS-C. Therefore, patients with MIS-A may respond to supportive therapies that control hyperinflammation. Although the incidence of MIS-A is unknown, as with MIS-C in children, MIS-A is likely to be an uncommon complication of SARS-CoV-2 infection in adults.
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