Disclosures: VAN T. NGUYEN, DO: No financial relationships or conflicts of interest

Case Diagnosis: 20 year old male with MIS-C

Case Description: Patient presented with headache, pharyngitis, maculopapular rash, fever, and hematochezia. Sars-CoV-2 PCR was negative; prior infection was determined by positive IgG, COVID-19 exposure history, and anosmia one month prior. He deteriorated with respiratory failure, shock, heart failure (initial ejection fraction (EF): 15%), liver/kidney injury, coagulopathy, and elevated inflammatory markers. Diagnosis was multisystem inflammatory syndrome-C (MIS-C). He required intubation, extracorporeal membrane oxygenation, vasopressors, and continuous veno-venous hemofiltration, however responded to steroids/IVIG. Upon extubation, he was encephalopathic, with decreased responsiveness.

Setting: Tertiary care hospital, Inpatient rehabilitation facility (IRF)Assessment/

Results: Initial PM&R exam showed profound weakness (motor scores 1-3/5, possible critical illness myopathy), with corresponding functional impairment (requiring maximal assistance to stand/hold head upright). Cognitive impairments remained (impaired memory/recall, processing/motor planning deficits). He improved over the following week with motor scores of 4-5/5 by IRF admission. Functional status continued to improve on the IRF while receiving IV steroids and rheumatology consultative care. He was functionally independent and at cognitive baseline by discharge (IRF stay 5 days). Post-discharge echocardiogram showed EF of 65%.

Discussion: We describe a MIS-C case that led to significant functional impairment in a previously healthy individual. Previous case series suggest a high probability of unfavorable outcomes in individuals with life-threatening neurologic conditions associated with COVID-19 and MIS-C (including severe encephalopathy). However this patient experienced an excellent recovery despite severe encephalopathy and involvement of nearly all organ systems. Encephalopathy is present in a minority of patients with MIS-C; this case adds to available literature on potential outcomes. The patient’s lack of co-morbidities and ability to receive interdisciplinary care during rehabilitation may have improved outcome.

Conclusion: MIS-C is a newly described sequelae of COVID-19. This patient demonstrated excellent short-term functional outcome despite severe involvement of multiple systems and demonstrates the benefit of IRF care in medically complex patients with MIS-C.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/multisystem-inflammatory-syndrome-associated-with-sars-cov-2-infection-a-case-report/