[First Cases of Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection in Adults in Germany]

Introduction:  Multisystem Inflammatory Syndrome is a rare condition that affects multiple organs following SARS-CoV-2 infection. It was first observed in children, however few cases of adults with Multisystem Inflammatory Syndrome (MIS-A) were published in the US and the UK. We present two cases of Multisystem Inflammatory Syndrome in adults which occurred in Germany.

History:  #1: A 27-year-old male presented with fever (40 °C), right lower abdominal pain, diarrhea and peritonism. #2: A 21-year-old female presented with fever (40 °C) occipital headaches, neck stiffness, and somnolence.

Findings:  #1: Increased inflammation parameters and elevated Nt-proBNP were found. Abdominal CT showed signs of ileitis terminalis and colitis. Crohn's disease was excluded endoscopically. Echocardiography showed minor pericardial effusion. A SARS-CoV-2 antibody test was positive. #2: Increased inflammation parameters and an increased Nt-proBNP were found. Cranial CT showed pathology. Meningitis was excluded via lumbar puncture. Thoracic CT and abdominal ultrasound showed no signs of infection. Echocardiography showed reduced LVEF (50 %). A SARS-CoV-2 antibody test was positive.

Therapy And Course:  #1: Antibiotic therapy as well as oral prednisolone didn't improve the clinical course. High-dose vasopressor therapy was necessary. The clinical condition improved only after adding hydrocortisone therapy. #2 Despite antibiotic therapy the clinical condition deteriorated. Because of insufficient effect of hydrocortisone, high-dose immunoglobulins were administered. Consequently, symptoms improved and LVEF normalized.

Conclusions:  Multisystem Inflammatory Syndrome presents as a chameleon of symptoms. In the context of the ongoing SARS-CoV-2 pandemic, rising numbers of cases in adults can be expected. In patients with fever, increased inflammation parameters and lack of other explanations, Multisystem Inflammatory Syndrome must be considered. Due to the potential severity of clinical courses and possible cardiac involvement, a therapy with hydrocortisone, ASS and immunoglobulins should be considered early.