J Korean Med Sci.  2022 Oct;37(41):e299. 10.3346/jkms.2022.37.e299.

Multisystem Inflammatory Syndrome in an Adult Following COVID-19 mRNA Vaccination: Successful Treatment With Medium-Dose Steroids and Colchicine

• Lee HJ
• Jeong YJ
• Kim YJ
• Kim SH

• KMID: 2534461
• DOI: http://doi.org/10.3346/jkms.2022.37.e299

Abstract

Multisystem inflammatory syndrome in children and adults (MIS-C/A) was rarely reported as a complication of coronavirus disease 2019 (COVID-19) and potential adverse events following COVID-19 vaccination. Recently, the case definition of MIS-C/A was developed by the Brighton Collaboration Network. However, only a limited number of adult patients with MIS-A following immunization have been reported, and there is still little evidence for adequate treatment. A 57-year-old man presented with fever, headache, vomiting, and hypotension 24 days after receiving the second COVID-19 vaccination with the PfizerBioNTech vaccine. According to the Brighton Collaboration Case Definition, the patient met a definitive case of MIS-A after vaccination (level 1 of diagnostic certainty). After administration of medium-dose prednisolone (20 mg/d) with colchicine (1.2 mg/d), all symptoms and signs improved rapidly. The dose of prednisolone was gradually tapered from the third week, and the patient confirmed a full recovery without medication after 8 weeks. This is the first report showing that low-dose steroids in combination with colchicine may be an effective treatment option for MIS-A after vaccination.

Keyword

Adult Multisystem Inflammatory Syndrome; SARS-CoV-2; COVID-19 Vaccine; Steroids; Colchicine

Figure

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  Fig. 1 Clinical course, laboratory findings, and treatment of the patient.ALT = alanine aminotransferase, AST = aspartate aminotransferase, COVID-19 = coronavirus disease 2019, CRP = C-reactive protein, ESR = erythrocyte sedimentation rate, NT-proBNP = N-terminal pro-B-type natriuretic peptide, PaO2 = arterial oxygen tension, PCR = polymerase chain reaction, SaO2 = arterial oxygen saturation, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2, WBC = white blood cell, HFNC = high flow nasal cannula.aOxygen therapy via nasal prong (5 L/min).bOxygen therapy by HFNC (forced inspiratory oxygen, 50–60%; flow rate, 40–45 L/min).

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  Fig. 2 CT scans at admission. Chest CT (A) and abdomen CT (B) show enlarged lymph nodes with soft tissue infiltrations (circles) in the left axilla and mesentery.CT = computed tomography.

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  Fig. 3 Transthoracic echocardiography. Apical four-chamber view (A) and substernal four-chamber view (B) show a moderate amount of pericardial effusion (asterisks).LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

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  Fig. 4 Diagnostic algorithm for the definitive case of MIS-A following SARS-CoV-2 vaccination in the patient: left column (blue), Brighton Collaboration Case Definition; right column (yellow), our patient.COVID-19 = coronavirus disease 2019, CRP = C-reactive protein, EKG = electrocardiogram, ESR = erythrocyte sedimentation rate, MIS-C/A = multisystem inflammatory syndrome in children and adults, BNP = B-type natriuretic peptide, NT-proBNP = N-terminal pro-B-type natriuretic peptide, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.

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