RESUMO
Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe complication in adults infected with SARS-CoV-2. However, the pathophysiology remains elusive, as the limited number of reports preclude a broader understanding of this syndrome. We conducted this systematic review to explore the clinical spectrum of MIS-A, in particular its rheumato-logical manifestations. Meta-analyses of case-series were also performed. We identified 28 patients from 14 case reports and two case series of MIS-A. This disease occurred equally in both genders, with a mean age of 33 + 10 years old, and predominantly in those of African descent (40%). Rheumatological manifestations consisted of Kawasaki Disease (KD)-like symptoms. Ninety percent of patients had positive COVID-19 serology tests, while 48% of patients were negative for COVID-19 RT-PCR test. Twelve patients were admitted to ICU and unfortunately two died. Although the signs and symptoms of MIS mimicked KD, the gastrointestinal findings were more prominent in the former group. The demographic make-up was also different, with MIS-A occurring mostly in those of African descent. Importantly, unlike their paediatric counterparts, the adult group did not have coronary artery abnormalities. Long-term monitoring is needed as safety data is scarce. Of note, although the prognosis of MIS-A is excellent, the life-threatening nature of this syndrome demands intensive care unit level of care and mechanical support. During the COVID-19 pandemic, a constellation of KD symptoms in an adult patient should alert the clinician to the possibility of MIS-A. © 2021 Asociación Colombiana de Reumatología. Published by Elsevier Espafña, S.L.U. All rights reserved.
El espectro clínico del síndrome inflamatorio multisistémico en adultos (MIS-A) es una complicación rara, pero grave en adultos infectados por el coronavirus del síndrome respiratorio agudo grave de tipo 2. Realizamos una búsqueda bibliográfica en varias bases de datos, y también se hizo en metanálisis. Identificamos 28 pacientes de 14 informes de casos y 2 series de casos de MIS-A. Esta enfermedad se manifestó por igual en ambos sexos, con una edad media de 33 + 10 anos, y se presentó predominantemente en afrodescendientes (40%). Las manifestaciones reumatológicas consistieron en síntomas similares a la enfermedad de Kawasaki (EK). El 90% de los pacientes tuvo pruebas positivas de serología de la enfermedad por el coronavirus de 2019 (COVID-19), mientras que el 48% dio negativo para la prueba de reacción en cadena de la polimerasa con transcriptasa inversa de la COVID-19. Doce pacientes ingresaron en la unidad de cuidados intensivos y, lamentablemente, 2 fallecieron. Encontramos que, si bien los signos y los síntomas de MIS imitaban a EK, los hallazgos gastrointestinales eran más prominentes en el primer grupo. Además, la composición demográfica fue asimismo diferente, con MIS-A que se presentó principalmente en afrodescendientes. Es importante destacar que, a diferencia de sus homólogos pediátricos, el grupo de los adultos no experimentó anomalías en las arterias coronarias. Se necesita un seguimiento a largo plazo, ya que los datos de seguridad son escasos. Es de destacar que, aun cuando el pronóstico de MIS-A es excelente, la naturaleza potencialmente mortal de este síndrome exige el nivel de atención y el soporte mecánico de la unidad de cuidados intensivos. Durante la pandemia por la COVID-19, una constelación de síntomas de EK en un paciente adulto debe alertar al médico sobre la posibilidad de MIS-A.
Assuntos
Humanos , Adulto , Reumatologia , Ocupações em Saúde , MedicinaRESUMO
The novel coronavirus SARS-CoV-2, which has similarities to the 2002-2003 severe acute respiratory syndrome coronavirus known as SARS-CoV-1, causes the infectious disease designated COVID-19 by the World Health Organization (Coronavirus Disease 2019). Although the first reports indicated that activity of the virus is centered in the lungs, it was soon acknowledged that SARS-CoV-2 causes a multisystem disease. Indeed, this new pathogen causes a variety of syndromes, including asymptomatic disease; mild disease; moderate disease; a severe form that requires hospitalization, intensive care, and mechanical ventilation; multisystem inflammatory disease; and a condition called long COVID or postacute sequelae of SARS-CoV-2 infection. Some of these syndromes resemble previously described disorders, including those with no confirmed etiology, such as Kawasaki disease. After recognition of a distinct multisystem inflammatory syndrome in children, followed by a similar syndrome in adults, various multisystem syndromes occurring during the pandemic associated or related to SARS-CoV-2 began to be identified. A typical pattern of cytokine and chemokine dysregulation occurs in these complex syndromes; however, the disorders have distinct immunological determinants that may help to differentiate them. This review discusses the origins of the different trajectories of the inflammatory syndromes related to SARS-CoV-2 infection.