MIS was first described in a letter published in the British journal The Lancet in May 2020. A group of pediatricians identified eight children, most of whom had been exposed to documented Covid-19, who came to a London hospital with a relentless fever, abdominal pain and diarrhea. Their blood pressures were extremely low, and tests showed their hearts were not working well. Doctors caring for these patients suggested that it was an immune system overreaction triggered by coronavirus infection. Just a few weeks later, The Washington Post reported several cases of young adults who were eventually hospitalized with a similar illness called MIS-A. While it remains unclear how even a mild infection with SARS CoV-2 can cause this life-threatening illness, treatment with steroids, a class of immunosuppressive drugs, has been shown to help.
Is Child an Adult with Syndrome?
Look, before recommending this rare diagnosis, a colleague, Dr. Reached Bindu Balani. “I accepted a patient … and found his case very interesting, so I’m following up. I wonder if it has MIS-C,” he wrote. “I wonder what you’re thinking.” Balani, who is on vacation with his family, is 33 years old because he does not have access to a computer right away. he texted. He was curious though, and later that day he found a computer to read the patient. Its presentation was fully compatible with MIS. And he knew that the syndrome occurs in adults. He called the colleague assigned to the patient’s case and suggested the diagnosis and explained that the emergency doctor recommended it to him.
MIS in children or adults can only be diagnosed when infection is ruled out. In this patient’s case, she was treated with antibiotics for days and did not get better, and none of the tests sent to look for other types of infections came back positive. The possibility of MIS-A was discussed with all relevant experts, and the patient was started on high-dose steroids the next day.
The answer was given immediately. Within 24 hours, both her fever and diarrhea were gone. He managed to get out of bed and walk around. He was hungry—something he hadn’t felt for a week. He was discharged from the hospital a few days later.
Recovery was difficult – both physically and mentally. It took weeks for her to start feeling herself again, and now, even 10 months later, she still feels short of breath when she rushes. But even worse are the scars that linger in his perception of who he is. He described himself to me as a “textbook tough guy.” And she took care of herself – she does not smoke, never used drugs, rarely drank. She tried to eat healthy foods and remained physically active. Despite all this, he came very close to dying. And even though his rational mind understood what had happened, there was still a part of him that was afraid – above all he was afraid that it would happen and afraid that it might happen again.
Lisa Sanders, MD, is a contributing author to the magazine. His most recent book is “Diagnostics: Solving the Most Surprising Medical Mysteries”. If you have a solved case to share, write to her at Lisa.Sandersmd@gmail.com.