A rare Covid complication is showing up in adults weeks after they have the virus

Erika EdwardsFri, October 16, 2020, 12:00 PM GMT+3

Femia, director of inpatient dermatology at NYU Langone Health in New York City, was looking at a patient's chart, which included several photos of the 45-year-old man who had, in recent weeks, cared for his wife while she was sick with Covid-19. The man had dusky-red circular patches on the palms of his hands and the soles of his feet. His eyes were pink, and his lips were extremely chapped. His body was erupting with the kind of extreme inflammation noted almost exclusively in children at the time. "Before I even saw the patient," Femia recalled, "I said: 'This hasn't been reported yet. This must be MIS-A.'"

MIS-A stands for "multi-system inflammatory syndrome in adults." When the condition was identified in children this spring, it was named MIS-C, with the C standing for "children." Kids were developing dangerous inflammation around the heart and other organs, often weeks after their initial infections with SARS-CoV-2, the virus that causes Covid-19.

The Centers for Disease Control and Prevention alerted physicians to MIS-C in May. As of Oct. 1, the CDC had reported 1,027 confirmed cases of MIS-C, with more cases under investigation. Twenty children have died.

In some cases, the children developed rashes like the one Femia noted in her adult patient. "The skin's right there in front of your eyes," Femia said. "You can't not see it."But many doctors may not, in fact, be recognizing the condition in adults. Just a few dozen cases of MIS-A have been reported. And not all patients have obvious rashes.

Negative tests Many MIS-A patients report fevers, chest pain or other heart problems, diarrhea or other gastrointestinal issues — but not shortness of breath. And diagnostic tests for Covid-19 tend to be negative. Instead, patients will test positive for Covid-19 antibodies, meaning they were infected two to six weeks previously, even if they never had symptoms. The illness can be life-threatening. Patients usually have some kind of severe dysfunction of at least one organ, such as the heart or the liver.

Ten patients in the CDC report needed to be hospitalized in intensive care units. Some needed to be put on ventilators. Two have died. Over the summer, doctors in Florida started seeing surges in Covid-19 cases. Dr. Lilian Abbo, chief of infection prevention for Jackson Health System in Miami, recalls a "very high volume of people coming through our emergency departments or hospitals getting very sick." It was then that Abbo discovered a subset of patients who were critically ill after having had Covid-19, but without the telltale pulmonary issues of an acute infection.

"We were a little disconcerted," Abbo said. "We would do the molecular PCR tests, and they would be negative. Then the antibody tests were positive." Further blood tests revealed extremely high levels of inflammation in the body.

What's more, while most severely ill Covid-19 patients tend to be over age 65 or to have multiple underlying health problems, these patients "were younger people that you would expect to not get sick," Abbo said. There's no proven treatment for MIS-A. "We need to recognize this syndrome and develop data" to figure out which therapies may be most effective," Abbo said. "We are all just shooting blind." This needs to be in the forefront of every intensive care unit physician's mind who's seeing patients, especially when they have Covid-19 antibodies. Physicians worry that many MIS-A patients will go undetected — and perhaps untreated.

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