SARS CoV-2-related multisystem inflammatory syndrome in adults: An observational case series from tropics

Background: Extrapulmonary multisystemic manifestations in children were recognized, early in the pandemic, Multisystem Inflammatory Syndrome in Children (MIS-C). Of late, similar manifestations have been reported in adults (Multisystem Inflammatory Syndrome in adults - MIS-A) in too. As new variants of SARS-CoV 2 emerge and fade away, MIS-A needs to be recognized at the most opportune time. Besides, we hypothesize that MIS-A may also co-exist with other tropical infections to further confuse diagnostic scenario. Methodology: A series of five cases of MIS-A is presented. Their demographic, comorbidities, and clinical data were noted. Besides, the clinical and laboratory parameters of patients with and without tropical infections were compared. Results: Patients presented with diverse heterogenous clinical manifestations. The cardiovascular, hematological, and abdominal systems were most commonly involved along with high inflammatory markers. Three of our patients in the present series had tropical infections along with MIS-A. There was no statistically significant difference between clinical manifestations and laboratory parameters among MIS-A patients with and without tropical infections. All the five patients improved on treatment and were discharged home. Conclusions: A high index of suspicion is required to diagnose MIS-A, especially in tropical areas where background rate of other infections is also high. Moreover, these tropical infections may co-occur along with MIS-A, further confusing the diverse heterogenous clinical presentations. Patients with MIS-A may be critically ill, but outcomes are good if lifesaving immunosuppressive therapy is initiated on time.