Fatal Multisystem Inflamatory Syndrome in Adult After SARS-CoV-2 Natural Infection and COVID-19 Vaccination

Heather N. Grome; Michael Threlkeld; Steve Threlkeld; Charles Newman; Roosecelis Brasil Martines; Sarah Reagan-Steiner; Michael A. Whitt; Maria Gomes-Solecki; Nisha Nair; Mary-Margaret Fill; Timothy F. Jones; William Schaffner; John Dunn


Emerging Infectious Diseases. 2021;27(11):2914-2918. 

In This Article

Abstract and Introduction


We describe a fatal case of multisystem inflammatory syndrome in an adult with onset 22 days after a second dose of mRNA coronavirus disease vaccine. Serologic and clinical findings indicated severe acute respiratory syndrome coronavirus 2 infection occurred before vaccination. The immunopathology of this syndrome, regardless of vaccination status, remains poorly understood.


A multisystem inflammatory syndrome in children (MIS-C) and adults (MIS-A) occurring after coronavirus disease (COVID-19) has been identified; onset is ≈4–6 weeks after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.[1–3] A case definition for MIS-A has been developed by the Centers for Disease Control and Prevention (CDC);[4] MIS-A after vaccination is rare and remains of great clinical and public health interest.[5] We report a case study and histopathologic findings from a fatal MIS-A case after SARS-CoV-2 infection and subsequent complete COVID-19 vaccination.