J Korean Med Sci.  2021 Nov;36(45):e312. 10.3346/jkms.2021.36.e312.

Multisystem Inflammatory Syndrome in an Adult after COVID-19 Vaccination: a Case Report and Literature Review

• Park JW
• Yu SN
• Chang SH
• Ahn YH
• Jeon MH

• KMID: 2522553
• DOI: http://doi.org/10.3346/jkms.2021.36.e312

Abstract

As the number of people vaccinated increases, people who complain of adverse reactions continue to occur. We experienced a case characterized by low blood pressure, persistent fever, edema due to increased systemic vascular permeability, and systemic inflammation confirmed by image and laboratory examinations after ChAdOx1 coronavirus disease 2019 (COVID-19) vaccination. The diagnostic criteria for multisystem inflammatory syndrome (MIS) in adults are known as fever of 3 days or more in adults, 2 or more mucocutaneous/ gastrointestinal/neurologic symptoms, elevation of inflammatory markers, and clinical/ imaging diagnosis of heart failure. A 67-year-old man who was medicated for hypertension and diabetes was admitted complaining of fever, maculopapular rash, diarrhea, headache, chills, and dizziness 6 days after the first vaccination of ChAdOx1 nCoV-19 in Korea. The COVID-19 test was negative but with low blood pressure, leukocytosis, skin rash, pulmonary edema, and increased inflammation markers. His lab findings and clinical course were consistent with those of MIS after COVID-19 vaccination. He was medicated with methylprednisolone 1 mg/kg and diuretics and recovered rapidly. He was discharged after 2 weeks and confirmed cure at outpatient clinic. We report an MIS case after COVID-19 vaccination in Korea.

Keyword

Coronavirus Disease 2019 (COVID-19); COVID-19 Vaccination; Multisystem Inflammatory Syndrome; Methylprednisolone

Figure

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  Fig. 1 Clinical features of the patient. (A) Patient's Positron Emission Tomography findings: Lt. cervical chain, Lt. There are nodular FDG uptakes in the supraclavicular region, both axillae and mediastinum. Moreover, there is nodular uptake in the portocaval (SUVmax: 4.06) and pericaval (3.54) regions. Lt. Mild nodular uptakes in the paraaortic region, bilateral external iliac chains, and inguinal regions. Spleen's FDG uptake increased overall. (B) Maculopapular rash finding developed in the patient.FDG = fluorodeoxyglucose.

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  Fig. 2 Patient's clinical course: changes in vital sign indicators and laboratory results. (A) Vital sings; (B) Laboratory tests: WBC count, lactic acid, CRP (C) Ferritin levels (ng/mL).MBP = mean blood pressure, WBC = white blood cell, CRP = C-reactive protein.

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