Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection — United Kingdom and United States, March–August 2020

Morris, Sapna Bamrah; Schwartz, Noah G.; Patel, Pragna; Abbo, Lilian; Beauchamps, Laura; Balan, Shuba; Lee, Ellen H.; Paneth-Pollak, Rachel; Geevarughese, Anita; Lash, Maura K.; Dorsinville, Marie S.; Ballen, Vennus; Eiras, Daniel P.; Newton-Cheh, Christopher; Smith, Emer; Robinson, Sara; Stogsdill, Patricia; Lim, Sarah; Fox, Sharon E.; Richardson, Gillian; Hand, Julie; Oliver, Nora T.; Kofman, Aaron; Bryant, Bobbi; Ende, Zachary; Datta, Deblina; Belay, Ermias; Godfred-Cato, Shana

During the course of the coronavirus disease 2019 (COVID-19) pandemic, reports of a new multisystem inflammatory syndrome in children (MIS-C) have been increasing in Europe and the United States (1-3). Clinical features in children have varied but predominantly include shock, cardiac dysfunction, abdominal pain, and elevated inflammatory markers, including C-reactive protein (CRP), ferritin, D-dimer, and interleukin-6 (1). Since June 2020, several case reports have described a similar syndrome in adults; this review describes in detail nine patients reported to CDC, seven from published case reports, and summarizes the findings in 11 patients described in three case series in peer-reviewed journals (4-6). These 27 patients had cardiovascular, gastrointestinal, dermatologic, and neurologic symptoms without severe respiratory illness and concurrently received positive test results for SARS-CoV-2, the virus that causes COVID-19, by polymerase chain reaction (PCR) or antibody assays indicating recent infection. Reports of these patients highlight the recognition of an illness referred to here as multisystem inflammatory syndrome in adults (MIS-A), the heterogeneity of clinical signs and symptoms, and the role for antibody testing in identifying similar cases among adults. Clinicians and health departments should consider MIS-A in adults with compatible signs and symptoms. These patients might not have positive SARS-CoV-2 PCR or antigen test results, and antibody testing might be needed to confirm previous SARS-CoV-2 infection. Because of the temporal association between MIS-A and SARS-CoV-2 infections, interventions that prevent COVID-19 might prevent MIS-A. Further research is needed to understand the pathogenesis and long-term effects of this newly described condition.