MIS was first described in May 2020 in a letter published in the British journal The Lancet. A group of pediatricians described eight children, most of whom had some documented exposure to Covid-19, who came to a London hospital with unrelenting fevers, abdominal pain and diarrhea. Their blood pressures were extremely low, and testing showed that their hearts were not working well. The doctors caring for these patients postulated that this was an immune-system overreaction, triggered by infection with the coronavirus. Just a couple of weeks later, The Washington Post reported several cases of young adults who were hospitalized with a similar illness, eventually called MIS-A. Although it remains unclear how even a mild infection with SARS CoV-2 might cause this life-threatening disorder, treatment with steroids, a class of drugs that suppresses the immune system, has been shown to help.
An Adult With a Children’s Syndrome?
Before suggesting this rare diagnosis, Bak reached out to a colleague, Dr. Bindu Balani, an infectious-disease specialist at the hospital. “I admitted a patient … and find his case very intriguing, so I’ve been following up. I am wondering if he may have MIS-C,” she wrote. “Curious what you think.” Balani, who was on vacation with her family, didn’t have immediate access to a computer and texted back, “He is a 33 yr old!” Still, she was curious and found a computer later that day to read up on the patient. His presentation was totally consistent with MIS. And she knew the syndrome had been seen in adults. She called her colleague who was assigned to the patient’s case and proposed the diagnosis, explaining that the E.R. doctor had suggested it to her.
MIS in either children or adults can be diagnosed only when infection has been ruled out. In this patient’s case, he was on antibiotics for days without improvement, and none of the tests sent to look for other types of infection had been positive. The possibility of MIS-A was discussed with all the specialists involved, and the following day the patient was started on high-dose steroids.
The response was immediate. Within 24 hours both the fever and the diarrhea were gone. He was able to get out of bed and walk around. He was hungry — something he hadn’t felt in over a week. He was discharged from the hospital a few days later.
Recovery was tough — both physically and mentally. It took weeks before he started to feel himself again, and even now, 10 months later, he still feels out of breath when he hurries. But even worse are the scars left on his sense of who he is. He described himself to me as a “textbook tough guy.” And he took care of himself — not a smoker, never used drugs, rarely drank. He tried to eat healthy foods and stayed physically active. Despite all that, he came close to dying. And though his rational mind understood what happened, there was part of him that was still afraid — frightened it happened in the first place, and terrified it could happen again.
Lisa Sanders, M.D., is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries.” If you have a solved case to share, write her at Lisa.Sandersmd@gmail.com.
