Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults | Global Health | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Clinical Characteristics of Multisystem Inflammatory Syndrome in AdultsA Systematic Review

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are the clinical characteristics of multisystem inflammatory syndrome in adults (MIS-A)?

Findings  This systematic review of patients with MIS-A reported in the literature and to the US Centers for Disease Control and Prevention identified 221 patients worldwide. The syndrome presented approximately 4 weeks after acute COVID-19 with hyperinflammation and extrapulmonary multiorgan involvement that may be difficult to discern from acute biphasic COVID-19 and postacute sequelae of SARS-CoV-2 infection.

Meaning  These findings suggest that MIS-A occurs in the postacute COVID-19 period with a heterogeneous clinical presentation likely owing to a dysregulated immune response.

Abstract

Importance  Multisystem inflammatory syndrome in adults (MIS-A) has not been well described. Improved diagnosis and treatment of MIS-A might mitigate COVID-19 morbidity and mortality.

Objective  To summarize the descriptive epidemiology and clinical characteristics of MIS-A.

Evidence Review  This systematic review identified patients with MIS-A using 3 strategies: (1) literature review from May 1, 2020, to May 25, 2021, by searching MEDLINE, Embase, Global Health, CAB Abstracts, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Academic Search Complete, Scopus, World Health Organization Global COVID-19 Literature Database, and Google Scholar; (2) voluntary reports of MIS-A to the Centers for Disease Control and Prevention (CDC); and (3) reports among persons aged 18 to 20 years in the CDC surveillance system for MIS in children.

Findings  Of 221 patients with MIS-A, the median age was 21 (interquartile range [IQR], 19-34) years, and 154 of 219 (70%) with data available were men. Sixty of 169 patients (36%) were non-Hispanic Black individuals, and 122 of 209 (58%) had no underlying comorbidity. One hundred two of 149 patients (68%) noted a previous symptomatic COVID-19–like illness (median, 28 [IQR, 20-36] days previously). Most patients with MIS-A presented with fever (197 of 205 [96%]), hypotension (133 of 220 [60%]), cardiac dysfunction (114 of 210 [54%]), shortness of breath (102 of 198 [52%]), and/or diarrhea (102 of 197 [52%]). The median number of organ systems involved was 5 (IQR, 4-6). Median hospital stay was 8 (IQR, 5-12) days; 115 of 201 patients (57%) were admitted to the intensive care unit; 101 of 213 (47%) required respiratory support, and 15 of 220 (7%) died. Most patients (176 of 195 [90%]) had elevated markers of coagulopathy and/or inflammation and a positive SARS-CoV-2 serologic finding (139 of 194 [72%]). Ten patients with MIS-A presented with Kawasaki disease.

Conclusions and Relevance  These findings suggest that MIS-A is a serious hyperinflammatory condition that presents approximately 4 weeks after onset of acute COVID-19 with extrapulmonary multiorgan dysfunction.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Accepted for Publication: July 6, 2021.

Published: September 22, 2021. doi:10.1001/jamanetworkopen.2021.26456

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Patel P et al. JAMA Network Open.

Corresponding Author: Pragna Patel, MD, MPH, CDC COVID-19 Response, Division of Emergency Operations, Center for Preparedness and Response, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333 (plp3@cdc.gov).

Author Contributions: Drs Patel and Abrams had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Patel.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Patel.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Patel, DeCuir, Abrams.

Supervision: Patel, Godfred-Cato, Belay.

Conflict of Interest Disclosures: None reported.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).

Additional Contributions: We recognize all our state and local jurisdiction partners who submit cases to the US CDC through the surveillance system for multisystem inflammatory syndrome (MIS) in children, as well as those who work tirelessly to maintain the system, especially the CDC MIS data team.

References
1.
Centers for Disease Control and Prevention Coronavirus-19 (COVID-19) tracker. Updated January 5, 2021. Accessed on January 6, 2021. https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases
2.
Morris  SB , Schwartz  NG , Patel  P ,  et al.  Case series of multisystem inflammatory syndrome in adults associated with SARS-CoV-2 infection—United Kingdom and United States, March-August 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(40):1450-1456. doi:10.15585/mmwr.mm6940e1Google ScholarCrossref
3.
Belay  ED , Abrams  J , Oster  ME ,  et al.  Trends in geographic and temporal distribution of US children with multisystem inflammatory syndrome during the COVID-19 pandemic.   JAMA Pediatr. 2021;175(8):837-845. doi:10.1001/jamapediatrics.2021.0630PubMedGoogle ScholarCrossref
4.
Centers for Disease Control and Prevention. Health department-reported cases of multisystem inflammatory syndrome in children (MIS-C) in the United States. Reviewed June 25, 2021. Accessed December 24, 2020. https://www.cdc.gov/mis/
5.
Sokolovsky  S , Soni  P , Hoffman  T , Kahn  P , Scheers-Masters  J .  COVID-19 associated Kawasaki-like multisystem inflammatory disease in an adult.   Am J Emerg Med. 2021;39:253.e1-253.e2. doi:10.1016/j.ajem.2020.06.053 PubMedGoogle ScholarCrossref
6.
Shaigany  S , Gnirke  M , Guttmann  A ,  et al.  An adult with Kawasaki-like multisystem inflammatory syndrome associated with COVID-19.   Lancet. 2020;396(10246):e8-e10. doi:10.1016/S0140-6736(20)31526-9 PubMedGoogle ScholarCrossref
7.
Newton-Cheh  C , Zlotoff  DA , Hung  J ,  et al.  Case 24-2020: a 44 year-old women with chest pain, dyspnea, and shock.   N Engl J Med. 2020;383(5):475-484. doi:10.1056/NEJMcpc2004975Google ScholarCrossref
8.
Jones  I , Bell  LCK , Manson  JJ , Last  A ; UCLH COVID Response Team.  An adult presentation consistent with PIMS-TS.   Lancet Rheumatol. 2020;2(9):e520-e521. doi:10.1016/S2665-9913(20)30234-4 PubMedGoogle ScholarCrossref
9.
Fox  SE , Lameira  FS , Rinker  EB , Vander Heide  RS .  Cardiac endotheliitis and multisystem inflammatory syndrome after COVID-19.   Ann Intern Med. 2020;173(12):1025-1027. doi:10.7326/L20-0882 PubMedGoogle ScholarCrossref
10.
Kofman  AD , Sizemore  EK , Detelich  JF , Albrecht  B , Piantadosi  AL .  A young adult with COVID-19 and multisystem inflammatory syndrome in children (MIS-C)–like illness: a case report.   BMC Infect Dis. 2020;20(1):716. doi:10.1186/s12879-020-05439-z PubMedGoogle ScholarCrossref
11.
Ventura  MJ , Guajardo  E , Clark  EH ,  et al.  Correspondence on “Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort” by Pouletty et al.   Ann Rheum Dis.Published online September 25, 2020. doi:10.1136/annrheumdis-2020-218959PubMedGoogle Scholar
12.
Chau  VQ , Giustino  G , Mahmood  K ,  et al.  Cardiogenic shock and hyperinflammatory syndrome in young males with COVID-19.   Circ Heart Fail. 2020;13(10):e007485. doi:10.1161/CIRCHEARTFAILURE.120.007485 PubMedGoogle Scholar
13.
Heikman  G , Kernis  M , Zeitouni  M ,  et al.  Coronavirus disease 2019 acute myocarditis and multisystem inflammatory syndrome in adult intensive and cardiac care units.   Chest. 2021;159(2):657-662. doi:10.1016/j.chest.2020.08.2099Google ScholarCrossref
14.
Cogan  E , Foulon  P , Cappeliez  O , Dolle  N , Vanfraechem  G , De Backer  D .  Multisystem inflammatory syndrome with complete Kawasaki disease features associated with SARS-CoV-2 infection in a young adult: a case report.   Front Med (Lausanne). 2020;7:428. doi:10.3389/fmed.2020.00428 PubMedGoogle ScholarCrossref
15.
Chowdhary  A , Joy  E , Plein  S , Abel-Rahman  S .  Multisystem inflammatory syndrome in an adult with SARS-CoV-2 infection.   Eur Heart J Cardiovasc Imaging. 2021;22(5):e17. doi:10.1093/ehjci/jeaa232PubMedGoogle Scholar
16.
Othenin-Girard  A , Regamey  J , Lamoth  F ,  et al.  Multisystem inflammatory syndrome with refractory cardiogenic shock due to acute myocarditis and mononeuritis multiplex after SARS-CoV-2 infection in an adult.   Swiss Med Wkly. 2020;150:w20387. doi:10.4414/smw.2020.20387PubMedGoogle Scholar
17.
Gulersen  M , Staszewski  C , Grayver  E ,  et al.  Coronavirus disease 2019 (COVID-19)–related multisystem inflammatory syndrome in a pregnant woman.   Obstet Gynecol. 2021;137(3):418-422. doi:10.1097/AOG.0000000000004256PubMedGoogle ScholarCrossref
18.
Razavi  AC , Chang  JL , Sutherland  A , Niyogi  A , Ménard  GE .  A 23-year-old man with multisystem inflammatory syndrome after mild COVID-19.   J Invest Med High Impact Case Rep. Published online November 25, 2020. doi:10.1177/2324709620974200Google Scholar
19.
Nicol  M , Cacoub  L , Baudet  M ,  et al.  Delayed acute myocarditis and COVID-19–related multisystem inflammatory syndrome.   ESC Heart Fail. 2020;7(6):4371-4376. doi:10.1002/ehf2.13047 PubMedGoogle ScholarCrossref
20.
Bonnet  M , Chamapagnac  A , Lantelme  P , Harbaoui  B .  Endomyocardial biopsy findings in Kawasaki-like disease associated with SARS-CoV-2.   Eur Heart J. 2020;41(39):3863-3864. doi:10.1093/eurheartj/ehaa588Google ScholarCrossref
21.
Chérif  MY , de Filette  JMK , André  S , Kamgang  P , Richert  B , Clevenbergh  P .  Coronavirus disease 2019–related Kawasaki-like disease in an adult: a case report.   JAAD Case Rep. 2020;6(8):780-782. doi:10.1016/j.jdcr.2020.06.023 PubMedGoogle ScholarCrossref
22.
Burgi Vieira  C , Ferreira  AT , Botelho Cardoso  F , Pelicano Paulos  J , Germano  N .  Kawasaki-like syndrome as an emerging complication of SARS-CoV-2 infection in young adults.   Eur J Case Rep Intern Med. 2020;7(10):001886. doi:10.12890/2020_001886PubMedGoogle Scholar
23.
Gomila-Grange  A , Espasa  M , Moglia  E .  Cardiogenic shock caused by SARS-CoV-2 in a patient with serial negative nucleic acid amplification tests: case report.   SN Compr Clin Med. Published online August 31, 2020. doi:10.1007/s42399-020-00496-6 PubMedGoogle Scholar
24.
Mogadam  P , Blum  L , Ahouach  B ,  et al.  Multisystem inflammatory syndrome with particular cutaneous lesions related to COVID-19 in a young adult.   Am J Med. 2021;134(1):e36-e37. doi:10.1016/j.amjmed.2020.06.025PubMedGoogle ScholarCrossref
25.
Parker  A , Louw  EH , Lalla  U ,  et al.  Multisystem inflammatory syndrome in adult COVID-19 patients.   S Afr Med J. 2020;110(10):957-958. doi:10.7196/SAMJ.2020.v110i10.15244 PubMedGoogle ScholarCrossref
26.
Ahsan  T , Rani  B .  A case of multisystem inflammatory syndrome post–COVID-19 infection in an adult.   Cureus. 2020;12(12):e11961. doi:10.7759/cureus.11961PubMedGoogle Scholar
27.
Chug  L , Cabrera  NM , Mathew  J , Lock  J , Burke  L , Sendon  C .  Multisystem inflammatory syndrome in an adult associated with COVID-19.   Crit Care Med. 2020;49(1):92. doi:10.1097/01.ccm.0000726740.59021.c1 Google ScholarCrossref
28.
Balan  S , Beauchamps  L , Gonzales-Zamora  JA ,  et al.  Recovery does not always signal the end of the battle: a case of post SARS-CoV-2 multisystem inflammatory syndrome in an adult.   IDCases. 2021;24:e01067. doi:10.1016/j.idcr.2021.e01067 PubMedGoogle Scholar
29.
Ghoddusi  F , Garcia  D , Harroun  T .  Post-COVID multisystem inflammatory syndrome in the deployed environment.   Mil Med. 2021;21:21. doi:10.1093/milmed/usab159PubMedGoogle Scholar
30.
Amato  MK , Hennessy  C , Shah  K , Mayer  J .  Multisystem inflammatory syndrome in an adult.   J Emerg Med. 2021;61(1):e1-e3. doi:10.1016/j.jemermed.2021.02.007 PubMedGoogle ScholarCrossref
31.
Bajaj  R , Sinclair  HC , Patel  K ,  et al.  Delayed-onset myocarditis following COVID-19.   Lancet Respir Med. 2021;9(4):e32-e34. doi:10.1016/S2213-2600(21)00085-0 PubMedGoogle ScholarCrossref
32.
Bastug  A , Aslaner  H , Aybar Bilir  Y ,  et al.  Multiple system inflammatory syndrome associated with SARS-CoV-2 infection in an adult and an adolescent.   Rheumatol Int. 2021;41(5):993-1008. doi:10.1007/s00296-021-04843-1 PubMedGoogle ScholarCrossref
33.
Diakite  S , Bousdira  N , Tachon  G , Ackermann  F , Groh  M , Rohmer  J .  Regression of coronary aneurysms with intravenous immunoglobulins and steroids for COVID-19 adult multisystem inflammatory syndrome.   JACC Case Rep. 2021;3(4):581-585. doi:10.1016/j.jaccas.2021.01.012 PubMedGoogle ScholarCrossref
34.
Lidder  AK , Pandit  SA , Lazzaro  DR .  An adult with COVID-19 Kawasaki-like syndrome and ocular manifestations.   Am J Ophthalmol Case Rep. 2020;20:100875. doi:10.1016/j.ajoc.2020.100875 PubMedGoogle Scholar
35.
Malangu  B , Quintero  JA , Capitle  EM .  Adult inflammatory multi-system syndrome mimicking Kawasaki disease in a patient with COVID-19.   Cureus. 2020;12(11):e11750. doi:10.7759/cureus.11750PubMedGoogle Scholar
36.
Mieczkowska  K , Zhu  TH , Hoffman  L ,  et al.  Two adult cases of multisystem inflammatory syndrome associated with SARS-CoV-2.   JAAD Case Rep. 2021;10:113-115. doi:10.1016/j.jdcr.2021.02.015 PubMedGoogle ScholarCrossref
37.
Shan  Y , Dalal  V , Nahass  RG , Rodricks  MB , Teichman  AL .  Multisystem inflammatory syndrome in an adult after COVID-19.   Infect Dis Clin Pract (Baltim Md). 2020;28(6):e28-e29. doi:10.1097/IPC.0000000000000938 Google ScholarCrossref
38.
Uwaydah  AK , Hassan  NMM , Abu Ghoush  MS , Shahin  KMM .  Adult multisystem inflammatory syndrome in a patient who recovered from COVID-19 postvaccination.   BMJ Case Rep. 2021;14(4):21. doi:10.1136/bcr-2021-242060 PubMedGoogle ScholarCrossref
39.
Varyani  U , Singhal  T , Sheth  S , Shetty  K , Harshe  P , Shah  S .  An unusual cause of fever and jaundice.   Indian J Med Microbiol. 2021;39(3):320-322. doi:10.1016/j.ijmmb.2021.02.001 PubMedGoogle ScholarCrossref
40.
Vujaklija Brajković  A , Zlopaša  O , Gubarev Vrdoljak  N , Goran  T , Lovrić  D , Radonić  R .  Acute liver and cardiac failure in multisystem inflammatory syndrome in adults after COVID-19.   Clin Res Hepatol Gastroenterol. 2021;45(3):101678. doi:10.1016/j.clinre.2021.101678 PubMedGoogle Scholar
41.
Yamada  Y , Fujinami  K , Eguchi  T , Takefuji  H , Mori  N .  Multisystem inflammatory syndrome in adults after mild SARS-CoV-2 infection, Japan.   Emerg Infect Dis. 2021;27(6):1740-1742. doi:10.3201/eid2706.210728 PubMedGoogle ScholarCrossref
42.
Riollano-Cruz  M , Akkoyun  E , Briceno-Brito  E ,  et al.  Multisystem inflammatory syndrome in children related to COVID-19: a New York City experience.   J Med Virol. 2021;93(1):424-433. doi:10.1002/jmv.26224 PubMedGoogle ScholarCrossref
43.
Bulathsinghala  M , Samson  R.   A case of COVID-19 associated multisystem inflammatory syndrome resulting in new onset heart failure in an adult.   J Invest Med. 2021;69(2):431. 2021 Southern Medical Research Conference abstract 38. doi:10.1136/jim-2021-SRMCGoogle Scholar
44.
Julius  MA , Cantrell  D , Sharif  S , Zelnik Yovel  D , Rapoport  MJ .  The first fatal post-COVID-19 adult patient with multi-system inflammatory syndrome in Israel.   Isr Med Assoc J. 2021;23(4):212-213.PubMedGoogle Scholar
45.
Pašara  V , Kutleša  M , Paar  MH ,  et al.  New fever and acute heart failure weeks after COVID-19—red flags for multisystem inflammatory syndrome in adults.   Cardiol Croatica. 2021;16(5-6):179. doi:10.15836/ccar2021.179 Google ScholarCrossref
46.
Bettach  E , Zadok  D , Weill  Y , Brosh  K , Hanhart  J .  Bilateral anterior uveitis as a part of a multisystem inflammatory syndrome secondary to COVID-19 infection.   J Med Virol. 2021;93(1):139-140. doi:10.1002/jmv.26229 PubMedGoogle ScholarCrossref
47.
Hou  L , Park  BJ , Singh  A ,  et al.  Successful continuation of pregnancy and delivery in a patient with Covid-19 complicated by multisystem inflammatory syndrome (MIS) and cardiogenic shock.   J Am Coll Cardiol. 2021;77(18):1966.Google ScholarCrossref
48.
Li  M , Haque  W , Vuppala  S , Tobias  E .  Rare presentation of multisystem inflammatory syndrome in an adult associated with SARS-CoV-2 infection: unilateral neck swelling.   BMJ Case Rep. 2021;14(5):12. doi:10.1136/bcr-2021-242392 PubMedGoogle Scholar
49.
Mastroianni  F , Butzko  R , Garcia-Bengochea  Y , Schneider  J , Hasan  Z .  A case of multisystem inflammatory syndrome and shock after COVID-19 in an adult.   Crit Care Med. 2021;49(1)(suppl 1):37. doi:10.1097/01.ccm.0000726312.25394.8fGoogle ScholarCrossref
50.
Parpas  A , Yudd  M , Dreisbach  AW , Michaud  J .  Post COVID 19 multisystem inflammatory syndrome in an older adult.   Ren Fail. 2021;43(1):530-532. doi:10.1080/0886022X.2021.1895839 PubMedGoogle ScholarCrossref
51.
Pombo  F , Seabra  C , Soares  V , Sá  AJ , Ferreira  I , Mendes  M .  COVID-19–related multisystem inflammatory syndrome in a young adult.   Eur J Case Rep Intern Med. 2021;8(4):002520. doi:10.12890/2021_002520PubMedGoogle Scholar
52.
Tung-Chen  Y , Algora-Martín  A , Rodríguez-Roca  S , Díaz de Santiago  A .  COVID-19 multisystemic inflammatory syndrome in adults: a not to be missed diagnosis.   BMJ Case Rep. 2021;14(4):13. doi:10.1136/bcr-2021-241696 PubMedGoogle ScholarCrossref
53.
Carroll  E , Neumann  H , Aguero-Rosenfeld  ME ,  et al.  Post–COVID-19 inflammatory syndrome manifesting as refractory status epilepticus.   Epilepsia. 2020;61(10):e135-e139. doi:10.1111/epi.16683 PubMedGoogle ScholarCrossref
54.
Lechien  JR , Hervochon  R , Hans  S .  Post–COVID-19 Kawasaki-like syndrome.   Ear Nose Throat J.Published online March 26, 2021. doi:10.1177/01455613211006011PubMedGoogle Scholar
55.
Veyseh  M , Webster  P , Blanco  I .  COVID-19–associated inflammatory syndrome in an adult woman with unexplained multiple organ failure: staying vigilant for COVID-19 complications as the pandemic surges.   BMJ Case Rep. 2021;14(4):12. doi:10.1136/bcr-2021-242034 PubMedGoogle Scholar
56.
Viana-García  A , Pina-Belmonte  A , Salavert-Pamblanco  S , Atienza-Garcia  A .  Multisystemic inflammatory syndrome in a young adult after SARS-CoV-2 infection: case report.   J Med Virol. 2021;93(9):5243-5245. doi:10.1002/jmv.27083 PubMedGoogle ScholarCrossref
57.
Ben-Yakov  M , James  V .  Young man with a diffuse rash and red eyes after recovery from COVID-2019.   J Am Coll Emerg Physicians Open. 2021;2(2):e12404. doi:10.1002/emp2.12404PubMedGoogle Scholar
58.
Dahl  EH , Mosevoll  KA , Cramariuc  D , Vedeler  CA , Blomberg  B .  COVID-19 myocarditis and postinfection Bell’s palsy.   BMJ Case Rep. 2021;14(1):11. doi:10.1136/bcr-2020-240095 PubMedGoogle ScholarCrossref
59.
Kaushik  S , Aydin  SI , Derespina  KR ,  et al.  Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 infection (MIS-C): a multi-institutional study from New York City.   J Pediatr. 2020;224:24-29. doi:10.1016/j.jpeds.2020.06.045 PubMedGoogle ScholarCrossref
60.
Ragoonanan  D , Khazal  SJ , Mejia  R ,  et al.  Case discussion and literature review: cancer immunotherapy, severe immune-related adverse events, multi-inflammatory syndrome, and severe acute respiratory syndrome coronavirus 2.   Front Oncol. 2021;11(32):625707. doi:10.3389/fonc.2021.625707 PubMedGoogle Scholar
61.
Davogustto  GE , Clark  DE , Hardison  E ,  et al.  Characteristics associated with multisystem inflammatory syndrome among adults with SARS-CoV-2 infection.   JAMA Netw Open. 2021;4(5):e2110323. doi:10.1001/jamanetworkopen.2021.10323 PubMedGoogle Scholar
62.
Razmi  TM , Afra  TP , Mohammed  TP , Ashik  PTM , Sukesh  E .  COVID-19-associated multisystem inflammatory syndrome in adults with Kawasaki disease-like cutaneous manifestations.   Brit J Dermatol. Published online May 25, 2021. doi:10.1111/bjd.20425Google Scholar
63.
Baruah  R , Gupta  R .  Case report on a young patient with multisystem inflammatory syndrome in adult (MIS-A).   Ann Med Health Sci Res. 2021;11(4):1385-1387. Accessed August 17, 2021. https://www.amhsr.org/articles/case-report-on-a-young-patient-with-multisystem-inflammatory-syndrome-in-adult-misa.pdfGoogle Scholar
64.
Balavoine  JF .  Multisystem inflammatory syndrome associated with COVID-19 in adults.  Article in French.  Rev Med Suisse. 2020;16(713):2146.PubMedGoogle Scholar
65.
Berntson  L , von Seth  M , Bülow Anderberg  S , Åkerström  T , Kurland  S .  Rare but potentially life-threatening: multisystem inflammatory syndrome in adults—a case description.  Article in Swedish.  Lakartidningen. 2021;118:21084.PubMedGoogle Scholar
66.
Elouardi  Y , Houssam  R , Zarrouki  Y , Ziadi  A , Younous  S , Samkaoui  MA .  COVID-19 associated Kawasaki-like multisystem inflammatory syndrome in an adult.   Rev Esp Anestesiol Reanim (Engl Ed). Published online December 26, 2020. doi:10.1016/j.redar.2020.11.013Google Scholar
67.
Karthika  IK , Gulla  KM , John  J ,  et al.  COVID-19 related multi-inflammatory syndrome presenting with uveitis: a case report.   Indian J Ophthalmol. 2021;69(5):1319-1321. doi:10.4103/ijo.IJO_52_21 PubMedGoogle Scholar
68.
Salzman  MB , Huang  CW , O’Brien  CM , Castillo  RD .  Multisystem inflammatory syndrome after SARS-CoV-2 infection and COVID-19 vaccination.   Emerg Infect Dis. 2021;27(7):1944-1948. doi:10.3201/eid2707.210594 PubMedGoogle ScholarCrossref
69.
Alonso  RS , Alonso  FOM , Fernandes  BF , Ecard  VO , Ventura  MP .  COVID-19–related ocular hypertension secondary to anterior uveitis as part of a multisystemic inflammatory syndrome.   J Glaucoma. 2021;30(5):e256-e258. doi:10.1097/IJG.0000000000001835 PubMedGoogle ScholarCrossref
70.
Atmaca  SB , Schuurbier  J , Den Uil  CA ,  et al.  Post COVID-19 multisystem inflammatory syndrome in adults: a case series.   J Clin Immunol. 2021;41(suppl 1):S33-S34. doi:10.1007/s10875-021-01001-xGoogle Scholar
71.
Downing  S , Chauhan  V , Chaudry  IH , Galwankar  S , Sharma  P , Stawicki  SP .  Colchicine, aspirin, and montelukast: a case of successful combined pharmacotherapy for adult multisystem inflammatory syndrome in COVID-19.   J Glob Infect Dis. 2020;12(4):221-224. doi:10.4103/jgid.jgid_296_20 PubMedGoogle Scholar
72.
Centers for Disease Control and Prevention. Kawasaki disease case definition. Reviewed October 24, 2018. Accessed June 20, 2021. https://www.cdc.gov/kawasaki/case-definition.html
73.
National Institutes of Health. Coronavirus disease 2019 (COVID-19) treatment guidelines. Updated August 4, 2021. Accessed January 7, 2021. https://www.covid19treatmentguidelines.nih.gov/
74.
Gupta  A , Madhavan  MV , Sehgal  K ,  et al.  Extrapulmonary manifestations of COVID-19.   Nat Med. 2020;26(7):1017-1032. doi:10.1038/s41591-020-0968-3 PubMedGoogle ScholarCrossref
75.
Hanson  KE , Caliendo  AM , Arias  CA ,  et al. Infectious Diseases Society of America guidelines on the diagnosis of COVID-19: serologic testing. Infectious Diseases Society of America. August 18, 2020. Accessed December 24, 2020. https://www.idsociety.org/practice-guideline/covid-19-guideline-serology/
76.
US Food & Drug Administration. EUA serology test performance. Updated May 25, 2021. Accessed December 19, 2020. https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/eua-authorized-serology-test-performance
77.
Bienvenu  LA , Noonan  J , Wang  X , Peter  K .  Higher mortality of COVID-19 in males: sex differences in immune response and cardiovascular comorbidities.   Cardiovasc Res. 2020;116(14):2197-2206. doi:10.1093/cvr/cvaa284 PubMedGoogle ScholarCrossref
78.
Centers for Disease Control and Prevention. Health equity considerations and racial and ethnic minority groups. Updated April 19, 2021. Accessed December 20, 2020. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html
79.
Stokes  EK , Zambrano  LD , Anderson  KN ,  et al.  Coronavirus disease 2019 case surveillance—United States, January 22–May 30, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(24):759-765. doi:10.15585/mmwr.mm6924e2 PubMedGoogle ScholarCrossref
80.
Bhala  N , Curry  G , Martineau  AR , Agyemang  C , Bhopal  R .  Sharpening the global focus on ethnicity and race in the time of COVID-19.   Lancet. 2020;395(10238):1673-1676. doi:10.1016/S0140-6736(20)31102-8 PubMedGoogle ScholarCrossref
81.
Lanza  K , Perez  LG , Costa  LB ,  et al.  Covid-19: the renin-angiotensin system imbalance hypothesis.   Clin Sci (Lond). 2020;134(11):1259-1264. doi:10.1042/CS20200492 PubMedGoogle ScholarCrossref
82.
Webb  BJ , Peltan  ID , Jensen  P ,  et al.  Clinical criteria for COVID-19–associated hyperinflammatory syndrome: a cohort study.   Lancet Rheumatol. 2020;2(12):e754-e763. doi:10.1016/S2665-9913(20)30343-X PubMedGoogle ScholarCrossref
83.
Weatherhead  JE , Clark  E , Vogel  TP , Atmar  RL , Kulkarni  PA .  Inflammatory syndromes associated with SARS-CoV-2 infection: dysregulation of the immune response across the age spectrum.   J Clin Invest. 2020;130(12):6194-6197. doi:10.1172/JCI145301 PubMedGoogle ScholarCrossref
84.
Weisberg  SP , Connors  TJ , Zhu  Y ,  et al.  Distinct antibody responses to SARS-CoV-2 in children and adults across the COVID-19 clinical spectrum.   Nat Immunol. 2021;22(1):25-31. doi:10.1038/s41590-020-00826-9 PubMedGoogle ScholarCrossref
85.
Tahaghoghi-Hajghorbani  S , Zafari  P , Masoumi  E ,  et al.  The role of dysregulated immune responses in COVID-19 pathogenesis.   Virus Res. 2020;290:198197. doi:10.1016/j.virusres.2020.198197 PubMedGoogle Scholar
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close