Development of mis-a in a fully vaccinated patient with covid-19 infection: vaccine limitations

Introduction: Multisystem Inflammatory Syndrome in Adults (MIS-A) is a rare but severe complication associated with COVID-19 infection in which diffuse inflammation involving multiple organ systems ensues. This condition is commonly described as a sequela in patients with moderate to severe COVID-19 pneumonia. Herein, we describe the case of a 74-year-old female patient who was previously fully vaccinated and developed MIS-A after hospitalization for COVID-19 pneumonia. Description: The patient is a 74-year-old female who presented with fever, chills, and shortness of breath. Of note, the patient was discharged four weeks prior, after hospitalization for COVID-19 pneumonia, and treated with dexamethasone and Remdesivir. During that hospitalization, the patient was noted to be hypoxic on 2 liters via nasal cannula. However, the patient’s oxygenation status improved during the hospitalization, and she was discharged home two weeks prior on oral dexamethasone. On arrival at ED, the patient was notably hypotensive, tachycardic, tachypneic, febrile, and hypoxic to 88% on room air. Labs showed CRP at 49, IL-6 at 9.51, creatinine level 2.27, and troponin at 1.83. Computed tomography (CT) chest with contrast showed moderate right and multiple basal left pulmonary embolism. The patient was subsequently admitted to medical floors with a diagnosis of post covid inflammatory pneumonitis, pulmonary embolism, and possible myocarditis. The patient’s condition worsened during the hospital stay; she was diagnosed with super-added bacterial pneumonia and subsequent sepsis and passed away in the ICU after the family decided to focus on comfort measures. Discussion: The CDC guidelines for diagnosing MIS-A require fever, multi-organ involvement, and elevated inflammatory markers after a recent COVID-19 infection. There have been multiple reported cases, and they have all been in patients with severe COVID-19 pneumonia. After completing her vaccination series, our patient developed COVID-19 infection and subsequent MIS-A. To our knowledge, this is the first reported case of MIS-A in a fully vaccinated patient, adding to the literature that vaccinations, though they prevent severe COVID-19 infection, may not completely prevent the development of rare long-term complications.