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Presentation of multisystem inflammatory syndrome varies in adults

Patients with multisystem inflammatory syndrome in adults (MIS-A) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have a heterogeneous clinical presentation, according to a research letter published online May 19 in JAMA Network Open.

Giovanni E. Davogustto, M.D., from Vanderbilt University Medical Center in Nashville, Tennessee, fda black box warning for actos and colleagues conducted a single-center study to describe the spectrum of MIS-A presentation after SARS-CoV-2 infection. Of 839 patients admitted with a positive SARS-CoV-2 test result, 156 were classified as being at risk for MIS-A, and of these patients, 15 met the criteria for MIS-A.

The researchers found that patients with MIS-A were younger than those admitted for acute COVD-19 symptoms (median age, 45.1 versus 56.5 years) and were more likely to have evidence of SARS-CoV-2 infection documented by serological testing (60.0 percent versus no patients). Nine of the 15 patients (60.0 percent) with MIS-A had acute COVID-19 symptoms and 20.0 percent required admission for acute COVID-19 before MIS-A admission. During MIS-A admission, 33.3 percent of patients required intensive care treatment for hemodynamic monitoring, vasopressor support, or noninvasive ventilator support (three, one, and one patients, respectively). Three patients (20.0 percent) had MIS-A as a clinical diagnosis during MIS-A admission; 26.7 and 46.6 percent received immunosuppressive therapy and antibiotic therapy, respectively. There were no deaths. A median of four organ systems were involved, with the most commonly affected being the gastrointestinal, hematologic, and renal systems.

“These data suggest that, although uncommon, MIS-A has a more heterogeneous clinical presentation than previously appreciated and is commonly underdiagnosed,” the authors write.

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