Multisystem inflammatory syndrome after the Ad26.COV2.S vaccine

Abstract

Background: Multisystem inflammatory syndrome comprises a febrile, hyperinflammatory state, and life-threatening organ failure associated with SARS-CoV-2 infection or after immunization against COVID-19. The increasing number of cases of this syndrome makes it necessary to understand and generate timely and effective therapeutic approaches.

Objective: The objective of the article is to describe the clinical and laboratory data of a 20-year-old woman diagnosed with multisystem inflammatory syndrome after immunization with the Ad26.COV2.S vaccine.

Case presentation: A 20-year-old female patient presented with bilateral low back pain, myalgia, arthralgia, fever, and an evanescent salmon-colored rash on acupressure on the elbows, forearms, and ipsilateral hands. These symptoms began one month after the administration of the first dose of the vaccine. Janssen (Ad26.CoV2.S). Laboratory tests show elevated levels of leukocytes and acute phase reactants, broad-spectrum antibiotic management is started without clinical improvement. Urine and/or blood cultures are negative for bacterial growth, therefore antibiotic therapy is suspended. Diseases of autoimmune or hematolymphoid origin associated with the clinical picture were ruled out. Due to persistent clinical deterioration, high doses of corticosteroids are administered with clinical improvement and modulation of inflammatory markers.

Conclusions: Myalgia, arthralgia, fever, and rash are symptoms present in post-vaccination multisystem inflammatory syndrome. Immunomodulatory treatment with intravenous corticosteroids, by ruling out an active infectious process, improves the clinical course of the disease.