Taiwan Sees First Possible Case of MIS-A 30多歲患者多重器官發炎 疑國內首例MIS-A

Multisystem inflammatory syndrome can affect both children and adults after COVID-19 infection. Shin Kong Memorial Hospital recently started treating a person around 30 years old who developed a persistent fever and the inflammation of multiple organs after COVID-19 infection. This patient is thought to be the first case of MIS-A in Taiwan.

The COVID-19 situation in Taiwan remains in a "plateau." More and more cases of children developing multisystem inflammatory syndrome in children, or MIS-C, after COVID-19 infection are being reported. Adults can develop this condition too, but it's called MIS-A. Shin Kong Memorial Hospital recently started treating a person around 30 years old who developed a persistent fever and the inflammation of multiple organs after COVID-19 infection. This patient remains in an ICU, and is thought to be the first case of MIS-A in Taiwan.

Huang Chien-hsien, Director, Infectious Diseases Dept., Shin Kong Mem. Hosp.: “The patient had multiple organ inflammation, a high fever, shock, gastrointestinal symptoms, and eye symptoms, but no skin symptoms. That's why we can't confirm it yet.”

Doctors say symptoms of MIS-C include rashes and conjunctivitis, but fewer than half of MIS-A patients have skin and mucous membrane symptoms. As multiple organs are affected, it's difficult to diagnose from external appearance. It can also be confused with septicemia, so clinical diagnosis is not easy. Experts say a U.S. study from 2021 showed that if people exhibit five major symptoms including fever, low blood pressure, reduced heart function, and breathing difficulties in the one month following recovery, they may have MIS-A.

Huang Li-min, Honorary Chair, Infectious Diseases Society of Taiwan: “It primarily manifests as a fever and then a rash. There may be diarrhea, and people may feel that their heart is weaker and their blood pressure is lower. They may also find it harder to breathe. In terms of age groups, it still mostly occurs among young people. Those under the age of 40 are at a higher risk.”

Experts say the pathogenesis of MIS-A is still unknown, but it's believed to be caused by a dysregulated immune response. Further research is needed to determine if it's caused by COVID-19 or is a worsening of an existing disease. Taiwan only has clinical guidelines for treating MIS-C. There are no guidelines for treating MIS-A.

新冠本土疫情還在高原期，部分兒童確診後，會出現多系統發炎症候群，簡稱MIS-C，連成人也可能會發生、但簡稱為MIS-A。新光醫院日前收治一名30多歲左右年輕人，確診後因高燒不退，且出現多重器官發炎等症狀，目前仍在加護病房，疑似為國內首例MIS-A個案。

新光醫院感染科主任黃建賢表示：「他有多重器官發炎的現象，發高燒、有休克的現象，那也有腸胃道的症狀，有眼睛的症狀，但是他比較沒有皮膚的症狀，所以還沒有辦法確定。」

醫師表示，有別於MIS-C常見皮疹、結膜炎，MIS-A病例出現皮膚、黏膜症狀者不到一半，且多重器官侵犯從外觀很難看出，也容易和敗血症混淆，臨床診斷不容易；不過有專家提醒，美國去年研究發現，解隔後1個月內，若出現發燒、低血壓、心臟功能低下、喘等5大徵兆，就要提高警覺，很可能是MIS-A個案。

台灣感染症醫學會名譽理事長黃立民說明：「主要的表現就是發燒，然後出疹子，可能有腹瀉，另外就是可能會覺得心臟沒有力氣，血壓比較低，或者覺得會喘，年齡層來講還是普遍偏年輕，大概是40歲以下的，還是比較容易一點。」

專家強調，目前醫界尚未掌握MIS-A致病機轉，一般認為是免疫調節失能的結果，但到底是新冠病毒引發的，還是原本疾病惡化產生，還需更多研究，國內現階段只有兒童MIS-C臨床處置指引，尚未制定出成人MIS-A參考指引。