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New research suggests that an inflammatory complication from COVID-19 can occur in adults as well as children. FatCamera/Getty Images
  • Doctors diagnose multisystem inflammatory syndrome primarily in children, but it can also occur in older individuals.
  • Healthcare providers should suspect the syndrome in adults with elevated inflammatory symptoms.
  • While the illness is serious, prompt treatment can prevent severe outcomes.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.

New information continues to materialize on the aftereffects of COVID-19. Reported complications from the COVID-19 disease include blood clots, cardiovascular disease, kidney or liver injury, and post-COVID-19 syndrome.

Multisystem inflammatory syndrome is another serious complication that healthcare professionals see in some children testing positive for COVID-19.

While health professionals saw this rare but potentially severe COVID-19-related illness in younger patients initially, it has not proven exclusive to children. There have been a small number of adults younger than 50 years of age who have been diagnosed with this inflammatory syndrome.

Infectious disease specialists at the University of Calgary in Alberta recently published a case in the Canadian Medical Association Journal suggesting that age should not limit the potential diagnosis of multisystem inflammatory syndrome in adults.

Doctors Geneviève Kerkerian and Stephen D. Vaughan, authors of the case, reported that a 60-year-old man was diagnosed with the inflammatory condition.

The patient, who had tested positive for SARS-CoV-2 four weeks earlier, visited the hospital with a range of symptoms, including mild shortness of breath, profound fatigue, loss of appetite, a high fever, and a swollen lymph node.

During the exam, his doctors also noted his red eyes, swollen tongue, and a red blush at the end of his toes.

He did not have the more commonly reported symptoms of multisystem inflammatory syndrome such as stroke, shock, or cardiac dysfunction.

The doctors attributed this to either him having had a milder case of COVID-19 or the prompt diagnosis and interventions he received once at the hospital.

Accurately diagnosing the syndrome has proven challenging. “It’s a little bit tricky to diagnose,” Dr. William Schaffner, Professor of Infectious Diseases at Vanderbilt University Medical Center in Nashville, Tennessee, told Medical News Today. Dr. Schaffner was not involved in the research.

There is no single diagnostic test that will definitively indicate the presence of the syndrome. Schaffner compared diagnosis of the syndrome to putting together the pieces of a puzzle until reaching that “ah-ha” moment.

Symptoms of multisystem inflammatory syndrome are similar to those of the hyperinflammatory condition known as Kawasaki disease, which also primarily affects young children.

The American College of Rheumatology published a review comparing symptoms between multisystem inflammatory syndrome in children and Kawasaki disease. Of the children who met the diagnostic criteria for the syndrome, 25–50% also fulfilled the requirements for Kawasaki disease.

The male patient from the case study also met the criteria for Kawasaki disease. However, his recent contraction of the SARS-CoV-2 infection and age led doctors to look deeper into the possibility of multisystem inflammatory syndrome. Further testing showed an enlarged heart and a swollen lung. For this patient’s doctors, this was the “ah-ha” moment.

“Given the patient’s recent history of SARS-CoV-2 infection, fevers without localizing symptoms, oral mucosal changes, cervical lymphadenopathy, conjunctivitis, and lower extremity changes, we suspected inflammatory post-COVID-19 syndrome,” wrote Kerkerian and Vaughan.

The patient received treatment with aspirin and steroids. After 24 hours, he began to show signs of reduced inflammation in the eyes, tongue, and toes. His doctors discharged him after 5 days with a repeat electrocardiogram showing normal.

While multisystem inflammatory syndrome in children is rare, it is common enough that pediatricians are on high alert for this condition in patients testing positive for SARS-CoV-2. However, much is unknown about the syndrome in adults.

“It is critical that those who care for adults — the internists, family doctors, specialists, nurse practitioners, have a sense of this syndrome so that it can be recognized, diagnosed, and appropriately treated,” said Schaffner.

Optimal follow-up for multisystem inflammatory syndrome is currently unknown. However, experts agree that monitoring for coronary artery dilatation and aneurysm should play a major role.

The authors conclude by noting, “Unlike for MIS-C (multisystem inflammatory syndrome in children), there is currently no requirement to report cases of MIS-A (multisystem inflammatory syndrome in adults) to provincial or state authorities, but this should be encouraged to facilitate research and improve patient outcomes.”

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