Case Diagnosis: Post COVID-19 infection multisystem inflammatory syndrome in adults presenting in a 28-year-old African American female with pain, ascending weakness, paresthesias, and chest pain. Case Description or Program Description: Patient with documented COVID-19 infection 5 weeks prior to arrival and presented with pain, paresthesias, and weakness in the bilateral lower extremities. Symptoms began shortly after patient recovered from COVID-19 infection, however, patient developed ascending weakness extending into the hands with left sided chest pain, prompting patient to present for evaluation. Setting: Major academic and referral center with level 1 adult trauma. Assessment/Results: Lumbar puncture and cerebrospinal fluid studies were not suggestive of GuillainBarré syndrome. Imaging of the entire neuraxis was unremarkable. Echocardiogram revealed new onset heart failure with reduced ejection fraction of 35% consistent with non-ischemic cardiomyopathy and cardiac imaging was not suggestive of amyloidosis. EMG was consistent with primarily axonal greater than motor peripheral polyneuropathy. Further inflammatory workup revealed elevated erythrocyte sedimentation rate and C reactive protein. Paraneoplastic workup was unremarkable. Patient was started on intravenous immunoglobulin (IVIG) for suspected Multisystem Inflammatory Syndrome in Adults (MIS-A), however, patient developed infusion reaction shortly after infusion began and IVIG was discontinued pending hemodynamic stability. Discussion (relevance): Post COVID-19 multisystem inflammatory syndrome is seen more commonly in children than in adults per literature review. Clinicians must be mindful of potential MIS-A in adult patients with symptoms mimicking Guillain-Barré syndrome with negative workup and imaging, especially with concomitant cardiovascular compromise and elevated inflammatory markers. This case demonstrates one of the various presentations documented of MIS–A and is important for accurate diagnosis of this syndrome in the future. Conclusions: Post COVID-19 patients presenting with symptoms similar to Guillain-Barré syndrome with negative workup should be evaluated for MIS-A as this syndrome can affect multiple organ systems simultaneously, such as the nervous system and cardiovascular system as seen in this patient. Level of Evidence: Level V
Sielski D, Lou J, Bazil T, Grant L. Post COVID-19 infection multisystem inflammatory syndrome in adults presenting with pain, ascending weakness, and paresthesias: a case report. PM&R. 2022 Oct;14(S1):116.