Multisystem inflammatory syndrome following COVID-19 vaccination: ignored and underdiagnosed.

Abstract

• The patient in the article by Kono et al. developed fever and malaise post-second dose of COVID-19 vaccination. This was followed by dyspnoea and refractory type I respiratory failure. The investigations reveal raised C-reactive protein and D-dimer levels concordant with MIS. • The computed tomography revealed bilateral ground glass opacities with an apparent cardiomegaly in Figure 1 which shows dramatic recovery in both these findings in Figure 2. An underlying myocarditis only can explain such a rapid and complete reversal. There is no mention of any electrocardiogram and echocardiograph done in the patient which may have helped to narrow down the diagnosis. The patient was also extubated within 2 days of mechanical ventilation, which is unlikely for any interstitial lung disease. • The diagnosis of MIS-V is difficult and often relies on the existing diagnostic criteria for MIS in adults (MIS-A). Dysregulated hyperimmune response has been postulated as a probable underlying mechanism. Cardiac involvement along with mucocutaneous involvement are most commonly involved organs, besides gastrointestinal, musculo-skeletal, pulmonary and renal. The mainstay of treatment is steroids which leads to a rapid response. The patient had myalgia and respiratory failure for which musculoskeletal and cardiac evaluation is essential. Even if there was isolated myocarditis, which has increasingly been reported with messenger RNA vaccines throughout the world, the treatment essentially remains steroids only.