Postvaccination MIS in Adult With No Prior Infection

Abstract and Introduction

Abstract

Ten days after receiving the first dose of coronavirus disease vaccine, a 22-year-old woman in South Korea experienced myocarditis, myopathy, pericarditis, and gastroenteritis; rash subsequently developed. There was no evidence of prior infection with severe acute respiratory syndrome coronavirus 2. The diagnosis was multisystem inflammatory syndrome resulting from coronavirus disease vaccination.

Introduction

Multisystem inflammatory syndrome (MIS) is a serious complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that affects multiple body systems (cardiovascular, gastrointestinal, skin). It occurs predominantly in children (MIS-C)^[1] and only rarely in adults (MIS-A).^[2] The Brighton Collaboration Network (https://brightoncollaboration.us) includes MIS-C and MIS-A as possible coronavirus disease (COVID-19) vaccination–related adverse events.^[3] Most MIS cases occur in persons previously or concurrently infected with SARS-CoV-2.^[4–6] We report a case of MIS-A that occurred after vaccination of a patient with no evidence of prior SARS-CoV-2 infection.

Table. Laboratory results for patient with multisystem inflammatory syndrome after coronavirus disease vaccination but no evidence of prior infection with severe acute respiratory syndrome coronavirus 2, South Korea*
Measure	Reference	Hospital day
ED visit	1	2	4	8	15	22	29	36	39	50	60	64	68	73
Leukocyte count, × 10³ cells/μL	3.5−10.0	12.2	14.7	11.7	28.4	26.5	31.9	58.9	24.3	17.4	29.1	31.5	14.2	19.0	16.0	13.4
Erythrocyte count, × 10⁶ cells/μL	4.0−5.4	3.8	3.2	3.1	3.9	3.1	2.9	2.9	3.3	4.1	4.3	3.9	3.5	3.8	3.6	3.7
Absolute neutrophil count, × 10³/μL	1.9−7.4	11.1	13.0	10.3	27.1	24.8	31.4	54.3	22.42	14.7	26.6	19.2	12.1	15.7	13.4	10.2
Absolute lymphocyte count, × 10³ cells/μL	1.0−3.9	0.7	0.5	0.8	0.9	0.8	0.6	2.5	1.4	1.4	2.0	0.8	1.2	2.3	1.9	2.6
Platelet count, × 10³ cells/μL	130–400	169	159	157	245	168	367	282	274	269	330	177	288	277	182	186
Hemoglobin, g/dL	12–16	11.2	9.6	9.3	11.9	9.3	8.5	8.4	9.4	11.6	12.0	11.4	10.2	11.1	10.5	11.0
Hematocrit, %	36–46	33.7	27.9	28.4	34.2	27.5	24.6	24.2	28.6	34.5	35.9	33.2	30.2	33.1	31.5	33.4
CRP, mg/dL	0–0.5	30.7			>40	26.4	17.3	5.6	25.3	9.5	15.0	11.8	24.2	1.5	0.3	2.3
Procalcitonin, ng/mL	0–0.065	6.524			7.122	1.385	2.851	0.844	2.505	0.272	0.209	2.297	1.747	0.236	0.087	0.134
ESR, mm/h	0–20					49
IL-6, pg/mL	0–29.4							862.6		54.6	802.1	98.1			621.1	522.1
Ferritin, ng/mL	12–60			13,241		22,860		13,710	12,455			>10,000			4,918	3,595
Lactic acid, mEq/L	0.4–0.8	1.7	1.1	1.4	1.2	1.2	0.7	1.9	0.9
Sodium, mmol/L	136–145	130	134	139	137	134	131	128	132	137	134	137	138	138	140	141
Potassium, mmol/L	3.5–5.1	3.7	3.9	4.0	2.6	3.8	4.2	4.4	4.7	3.5	2.9	3.0	3.2	3.3	3.0	3.3
Chloride, mmol/L	98–110	100	108	113	104	101	99	99	102	102	94	98	98	99	99	100
CO₂, mmol/L	19–24	22	21	17	27	19	26	23	25
Calcium, mg/dL	8.4–10.2	8.1		7.3	7.4	7.5	8.1	7.8	7.9	8.2	8.0	8.2	8.7	8.7	8.7	9.2
Glucose, mg/dL	70–110	114	99	106	94	78	103	121	93	125	81	107	119	105	97	100
BUN, mg/dL	8–20	19.9	11.9	8.7	10.4	12.9	6.1	19.5	12.1	14.6	6.2	10.0	9.1	9.1	6.7	6.2
Creatinine, mg/dL	0.4–0.8	0.77	0.43	0.38	0.38	0.28	0.25	0.26	0.17	0.21	0.23	0.21	0.25	0.32	0.33	0.33
Total protein, g/dL	6.7–8.3	6.1		4.9	4.3	5.1	5.6	5.8	6.3	6.7	6.5	6.3	6.6	6.9	5.9	6.5
Albumin, g/dL	3.8–5.3	3.6		2.8	2.5	2.8	2.9	2.9	2.6	2.8	2.7	2.8	3.1	3.5	3.4	3.9
Total bilirubin, mg/dL	0.22–1.2	0.89		0.30	0.44	0.77	0.53	0.51	0.71	0.40	0.77	0.43	0.69	0.62	0.72	0.77
ALT, U/L	4–44	9		7	7	10	18	22	45	45	53	51	55	60	37	26
AST, U/L	8–38	22		32	31	34	50	43	36	57	50	33	31	54	45	31
ALP, U/L	42–98	58		44	65	84	98	103	185	110	130	137	115	102	80	83
CK, U/L	43–165	33	38	379			20	19	28			23			10	8
CK-MB, ng/mL	0.6–6.3	1.1	1.7	6.1			0.9	0.9	1.1			1.1			0.9	0.8
Troponin I, pg/mL	2.3–17.5	88.7	94.0	286.0		6.9	4.9	4.1							2.5	2.6
NT-proBNP, pg/mL	0–125			4,736		1,707	797	691	8,065	1,246	1,240	1,441			177	123
D-dimer, ng/mL	0–243	>3,200	>3,200		>3,200		>3,200				2,521	1,408			362	282
FDP, μg/mL	0–5	60.09			50.72		27.10
Fibrinogen, mg/dL	238–498		578		674										203	326
Anti-thrombin III, %	83–128		56		47
Protein C activity, %	70–130		58		52
Protein S activity, %	65–140		27		11
APTT, s	25.1–39.7	34.6	33.9	33.7	33.0	34.6	29.5	30.6	31.9			23.9
PT, s	9.4–13.6	19.4	18.1	15.9	17.8	19.1	17.9	18.0	14.7			14.0
INR	0.80–1.23	1.77	1.65	1.44	1.62	1.74	1.63	1.64	1.33			1.27
Anti-HPF4 antibody	Neg.			Neg.
LDH, U/L	200–400	511					1,428	1,472				1,161			1,279	1,417
Rheumatoid factor, IU/mL	0–18			8
C3, mg/dL	65–135			108
C4, mg/dL	13–35			19

Table. Laboratory results for patient with multisystem inflammatory syndrome after coronavirus disease vaccination but no evidence of prior infection with severe acute respiratory syndrome coronavirus 2, South Korea*

Measure

Reference

Hospital day

ED visit

Leukocyte count, × 10³ cells/μL

3.5−10.0

12.2

14.7

11.7

28.4

26.5

31.9

58.9

24.3

17.4

29.1

31.5

14.2

19.0

16.0

13.4

Erythrocyte count, × 10⁶ cells/μL

4.0−5.4

3.8

3.2

3.1

3.9

3.1

2.9

3.3

4.1

4.3

3.9

3.5

3.8

3.6

3.7

Absolute neutrophil count, × 10³/μL

1.9−7.4

11.1

13.0

10.3

27.1

24.8

31.4

54.3

22.42

14.7

26.6

19.2

12.1

15.7

13.4

10.2

Absolute lymphocyte count, × 10³ cells/μL

1.0−3.9

0.7

0.5

0.8

0.9

0.8

0.6

2.5

1.4

2.0

0.8

1.2

2.3

1.9

2.6

Platelet count, × 10³ cells/μL

130–400

169

159

157

245

168

367

282

274

269

330

177

288

277

182

186

Hemoglobin, g/dL

12–16

11.2

9.6

9.3

11.9

9.3

8.5

8.4

9.4

11.6

12.0

11.4

10.2

11.1

10.5

11.0

Hematocrit, %

36–46

33.7

27.9

28.4

34.2

27.5

24.6

24.2

28.6

34.5

35.9

33.2

30.2

33.1

31.5

33.4

CRP, mg/dL

0–0.5

30.7

>40

26.4

17.3

5.6

25.3

9.5

15.0

11.8

24.2

1.5

0.3

2.3

Procalcitonin, ng/mL

0–0.065

6.524

7.122

1.385

2.851

0.844

2.505

0.272

0.209

2.297

1.747

0.236

0.087

0.134

ESR, mm/h

0–20

IL-6, pg/mL

0–29.4

862.6

54.6

802.1

98.1

621.1

522.1

Ferritin, ng/mL

12–60

13,241

22,860

13,710

12,455

>10,000

4,918

3,595

Lactic acid, mEq/L

0.4–0.8

1.7

1.1

1.4

1.2

0.7

1.9

0.9

Sodium, mmol/L

136–145

130

134

139

137

134

131

128

132

137

134

137

138

140

141

Potassium, mmol/L

3.5–5.1

3.7

3.9

4.0

2.6

3.8

4.2

4.4

4.7

3.5

2.9

3.0

3.2

3.3

3.0

3.3

Chloride, mmol/L

98–110

100

108

113

104

101

102

100

CO₂, mmol/L

19–24

Calcium, mg/dL

8.4–10.2

8.1

7.3

7.4

7.5

8.1

7.8

7.9

8.2

8.0

8.2

8.7

9.2

Glucose, mg/dL

70–110

114

106

103

121

125

107

119

105

100

BUN, mg/dL

8–20

19.9

11.9

8.7

10.4

12.9

6.1

19.5

12.1

14.6

6.2

10.0

9.1

6.7

6.2

Creatinine, mg/dL

0.4–0.8

0.77

0.43

0.38

0.28

0.25

0.26

0.17

0.21

0.23

0.21

0.25

0.32

0.33

Total protein, g/dL

6.7–8.3

6.1

4.9

4.3

5.1

5.6

5.8

6.3

6.7

6.5

6.3

6.6

6.9

5.9

6.5

Albumin, g/dL

3.8–5.3

3.6

2.8

2.5

2.8

2.9

2.6

2.8

2.7

2.8

3.1

3.5

3.4

3.9

Total bilirubin, mg/dL

0.22–1.2

0.89

0.30

0.44

0.77

0.53

0.51

0.71

0.40

0.77

0.43

0.69

0.62

0.72

0.77

ALT, U/L

4–44

AST, U/L

8–38

ALP, U/L

42–98

103

185

110

130

137

115

102

CK, U/L

43–165

379

CK-MB, ng/mL

0.6–6.3

1.1

1.7

6.1

0.9

1.1

0.9

0.8

Troponin I, pg/mL

2.3–17.5

88.7

94.0

286.0

6.9

4.9

4.1

2.5

2.6

NT-proBNP, pg/mL

0–125

4,736

1,707

797

691

8,065

1,246

1,240

1,441

177

123

D-dimer, ng/mL

0–243

>3,200

2,521

1,408

362

282

FDP, μg/mL

0–5

60.09

50.72

27.10

Fibrinogen, mg/dL

238–498

578

674

203

326

Anti-thrombin III, %

83–128

Protein C activity, %

70–130

Protein S activity, %

65–140

APTT, s

25.1–39.7

34.6

33.9

33.7

33.0

34.6

29.5

30.6

31.9

23.9

PT, s

9.4–13.6

19.4

18.1

15.9

17.8

19.1

17.9

18.0

14.7

14.0

INR

0.80–1.23

1.77

1.65

1.44

1.62

1.74

1.63

1.64

1.33

1.27

Anti-HPF4 antibody

Neg.

LDH, U/L

200–400

511

1,428

1,472

1,161

1,279

1,417

Rheumatoid factor, IU/mL

0–18

C3, mg/dL

65–135

108

C4, mg/dL

13–35

Postvaccination Multisystem Inflammatory Syndrome in Adult With No Evidence of Prior SARS-CoV-2 Infection

Abstract and Introduction

Abstract

Introduction

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Postvaccination Multisystem Inflammatory Syndrome in Adult With No Evidence of Prior SARS-CoV-2 Infection

Abstract and Introduction

Abstract

Introduction

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Authors and Disclosures

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