He had no dysuria, urinary frequency, respiratory symptoms or rash. On the day of presentation, he had 5 episodes of diarrhoea, without blood and 3 episodes of vomiting. We describe a young man with colitis as the presenting feature of MIS-A and discuss the diagnostic difficulty and implications for practice.Ī 22-year-old man attended the Emergency Department with a 3-day history of non-radiating, right-sided abdominal pain of insidious onset and fever. The literature on MIS-A, although growing, remains sparse and is limited to small case series and reports, and as a result there are currently no clear guidelines for diagnosis or treatment of MIS-A. There remains variation in the case definition and nomenclature between Royal College of Paediatrics and Child Health (RCPCH) ( Harwood et al., 2021) Centers for Disease Control and Prevention (CDC) and World Health Organisation (WHO) ( World Health Organisation, 2020) however the key features are common to all three definitions: elevated inflammatory markers, persistent fever, multi-organ involvement and a temporal relationship with COVID-19 infection. MIS-A is related to the more established and reported multisystem inflammatory syndrome in children (MIS-C) ( World Health Organisation, 2020, Centers for Disease Control and Prevention (CDC), 2019), also known as paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) ( Royal College of Paediatrics and Child Health (RCPCH), 2020). MIS-A differs from COV-HI in that the inflammatory state presents weeks to months after the original infection (which may have been minimally symptomatic or asymptomatic), often when acute symptoms have subsided and nasal/throat SARS-CoV-2 RT-PCR testing is negative. MIS-A is an inflammatory condition affecting multiple extrapulmonary organ systems (cardiac, gastrointestinal tract, dermatological or neurological) ( Centers for Disease Control and Prevention (CDC), 2020), attributed to a post-infectious and atypical complication occurring weeks to months after infection with COVID-19 ( Morris et al., 2020, Tenforde and Morris, 2021).ĬOVID-19 associated hyper inflammation (COV-HI) in adults with acute COVID-19 infection is well described and is associated with poor patient outcome ( Manson et al., 2020). His blood tests have returned to normal and he has no lasting complications from his illness. His clinical condition dramatically improved and he was discharged home after 10 days in hospital. IVIg was added to the antibiotics on day 4. All microbiological and autoimmune screens performed return negative results but inflammatory markers were significantly elevated, he was diagnosed as MIS-A. He was transferred to critical care for vasopressor and respiratory support. Hypotension becomes increasingly pronounced and on the fourth day of admission he developed type 1 respiratory failure with evidence of fluid overload. Sustained fever and escalating blood markers of illness led to abdominal CT showing inflammation of ascending colon as well as some loops of small bowel. He is initially admitted with a working diagnosis of gastroenteritis. Approximately 6 weeks later, he presents after 3 days of right-sided abdominal pain, diarrhoea and fever. We present a case of a young adult with suspected MIS-A who initially displayed symptoms and radiological findings of colitis.Ĭase: A 22-year-old male with no past medical history suffered a minor respiratory illness for a few days and tested positive on SARS-CoV-2 RT-PCR. Diagnostic criteria and treatment recommendations have yet to be clearly defined. It involves inflammation of multiple extra-pulmonary organ systems. Multisystem Inflammatory Syndrome in Adults (MIS-A) is a recently emerging condition that occurs as a delayed complication of COVID-19 infection.
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