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Abstract: SA-PO042

Multisystem Inflammatory Syndrome in Adults: A Consequence of COVID-19

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Sarwal, Amara, University of Utah Health, Salt Lake City, Utah, United States
  • Ohri, Ritika, University of Utah Health, Salt Lake City, Utah, United States
  • Abraham, Josephine, University of Utah Health, Salt Lake City, Utah, United States
  • Cho, Monique E., University of Utah Health, Salt Lake City, Utah, United States
Introduction

An association between COVID-19 and a novel pediatric inflammatory condition, coined as multisystem inflammatory syndrome (MIS), has recently prompted an international alert. While multi-organ involvement of COVID-19 is common in all ages, reports of MIS have predominantly involved children. Herein, we present a case of an adult who presented with MIS.

Case Description

A 38 year-old Caucasian male, who had contracted COVID-19 two months prior to presentation, was admitted with 1-week history of abdominal pain, frontal headache, fever of 104° F and dark urine. His exam was notable for erythematous, blanching macular rash on his trunk and arms. He quickly progressed to shock, requiring vasopressor and ventilator support.

He developed acute kidney injury, with serum creatinine (SCr) increasing to 7.09 mg/dL from 1.9 mg/dL at presentation and required continuous renal replacement therapy (CRRT). Urinalysis revealed > 182 mostly non-dysmorphic RBCs and random urine protein-to-creatinine ratio of 1,273 mg/g. The previous urological evaluation was negative, prompting suspicion for IgA nephropathy. Serum IgG and IgE were elevated, with normal levels of IgA and IgM. Due to development of pulmonary infiltrate with hypoxia, there was concern for pulmonary-renal syndrome. The serologies were negative, including ANCA, anti-GBM, ANA, hepatitis B and C, HIV and complements. Blood cultures were also negative. Elevations were noted in interleukin (IL) 6 at 114.3 pg/mL, soluble IL-2 receptor at 42364.7 pg/mL, and IL-1β at 10.2 pg/mL. The patient had antibodies against COVID-19 IgG spike protein at 1.91 IV.

Skin biopsy revealed vacuolar interface dermatitis with eosinophils, consistent with MIS in adults (MIS-A) in the setting of recent COVID infection. The decision was made to treat with solumedrol and IVIG. Within 2 days of IVIG therapy, his renal function improved significantly. CRRT was discontinued and he was transferred out of ICU.

Three months following the hospitalization, his SCr improved to 0.9 mg/dL without hematuria.

Discussion

Acute renal injury is common in pediatric cases of MIS, with an excellent rate of renal recovery. The course and prognosis of renal injury in adults with MIS (MIS-A), however, have not been well described. Our case provides an important insight that even severe renal injury in MIS-A may carry a favorable prognosis with prompt immunomodulatory therapy.