A case of SARS-CoV-2 infection during the course of SLE difficult to differentiate NPSLE from multisystem inflammatory syndrome in adults (MIS-A).

Abstract

The global COVID-19 pandemic has also brought attention to multisystem inflammatory syndrome in adults (MIS-A), a post-COVID-19 complication. Here, we present a case of MIS-A caused by COVID-19 after the patient had systemic lupus erythematosus (SLE). A woman in her 30s developed SLE. Two years later, she became aware of arthralgia and febrile. On admission two weeks later, she had three episodes of generalized clonic seizure and a SARS-CoV-2 PCR test was positive. Blood tests showed elevated C-reactive protein (CRP) level. Cerebrospinal fluid was negative for bacterial culture but showed elevated IL-6. MRI FLAIR showed high signal in the brain surface from the right frontal to the temporal lobes. Antimicrobial agents, methylprednisolone pulse therapy and anticonvulsants were started on admission day. The seizures resolved, but the fever persisted and the CRP elevated again. Other conditions that might explain the severely elevated CRP were negative but the CDC 2020 diagnostic criteria for MIS-A was met. After a second methylprednisolone pulse and 3-day intravenous immunoglobulin therapy,her fever resolved, the CRP level decreased, and the MRI abnormalities and cerebrospinal fluid findings improved. Differential diagnosis is important when central nervous system symptoms are present in patients with SLE. If a patient develops neuropsychiatric manifestation after SARS-CoV-2 infection, possibility of MIS-A should be considered even in SLE patients.