{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T21:16:33Z","timestamp":1785186993867,"version":"3.55.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,23]],"date-time":"2021-06-23T00:00:00Z","timestamp":1624406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. A clinical series of Kawasaki-like multisystem inflammatory syndrome (MIS), occurring after SARS-CoV-2 infection, have been described in children (MIS-C) and adults (MIS-A), but the pathophysiology remains unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Presentation<\/jats:title><jats:p>We describe a case of post-COVID-19 MIS-A in a 46-year-old man with biopsy-proven renal thrombotic microangiopathy (TMA). Specific complement inhibition with eculizumab was initiated promptly and led to a dramatic improvement of renal function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our case suggests that that TMA could play a central role in the pathophysiology of post-COVID-19 MIS-A, making complement blockers an interesting therapeutic option.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2021.680567","type":"journal-article","created":{"date-parts":[[2021,6,23]],"date-time":"2021-06-23T04:39:27Z","timestamp":1624423167000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":24,"title":["Case Report: Adult Post-COVID-19 Multisystem Inflammatory Syndrome and Thrombotic Microangiopathy"],"prefix":"10.3389","volume":"12","author":[{"given":"Idris","family":"Boudhabhay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Rabant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lubka T.","family":"Roumenina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis-Marie","family":"Coupry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Poillerat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armance","family":"Marchal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u00e9ronique","family":"Fr\u00e9meaux-Bacchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalil","family":"El Karoui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehran","family":"Monchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franck","family":"Pourcine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30937-5","article-title":"Endothelial Cell Infection and Endotheliitis in COVID-19","volume":"395","author":"Varga","year":"2020","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-0968-3","article-title":"Extrapulmonary Manifestations of COVID-19","volume":"26","author":"Gupta","year":"2020","journal-title":"Nat Med"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa623","article-title":"Covid-19 Is, in the End, An Endothelial Disease","volume":"41","author":"Libby","year":"2020","journal-title":"Eur Heart J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2001634","DOI":"10.1183\/13993003.01634-2020","article-title":"Endothelial Cell Dysfunction: A Major Player in SARS-CoV-2 Infection (COVID-19)","volume":"56","author":"Huertas","year":"2020","journal-title":"Eur Respir J"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2021.02.026","article-title":"Acute Kidney Injury in Pediatric Patients Hospitalized With Acute COVID-19 and Multisystem Inflammatory Syndrome in Children Associated With COVID-19","author":"Basalely","year":"2021","journal-title":"Kidney Int"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2021680","article-title":"Multisystem Inflammatory Syndrome in U.S. Children and Adolescents","volume":"383","author":"Feldstein","year":"2020","journal-title":"N Engl J Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piaa069","article-title":"Multisystem Inflammatory Syndrome in Children During the Coronavirus 2019 Pandemic: A Case Series","volume":"9","author":"Chiotos","year":"2020","journal-title":"J Pediatr Infect Dis Soc"},{"key":"B9","doi-asserted-by":"publisher","first-page":"100527","DOI":"10.1016\/j.eclinm.2020.100527","article-title":"Multisystem Inflammatory Syndrome in Children: A Systematic Review","volume":"26","author":"Ahmed","year":"2020","journal-title":"EClinicalMedicine"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e8","DOI":"10.1016\/S0140-6736(20)31526-9","article-title":"An Adult With Kawasaki-Like Multisystem Inflammatory Syndrome Associated With COVID-19","volume":"396","author":"Shaigany","year":"2020","journal-title":"Lancet"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2020.06.053","article-title":"Covid-19 Associated Kawasaki-Like Multisystem Inflammatory Disease in an Adult","volume":"39","author":"Sokolovsky","year":"2021","journal-title":"Am J Emerg Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.08.2099","article-title":"Coronavirus Disease 2019 Acute Myocarditis and Multisystem Inflammatory Syndrome in Adult Intensive and Cardiac Care Units","volume":"159","author":"H\u00e9kimian","year":"2021","journal-title":"Chest"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e007485","DOI":"10.1161\/CIRCHEARTFAILURE.120.007485","article-title":"Cardiogenic Shock and Hyperinflammatory Syndrome in Young Males With Covid-19","volume":"13","author":"Chau","year":"2020","journal-title":"Circ Heart Fail"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.7326\/L20-0882","article-title":"Cardiac Endotheliitis and Multisystem Inflammatory Syndrome After Covid-19","volume":"173","author":"Fox","year":"2020","journal-title":"Ann Intern Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcpc2004975","article-title":"Case 24-2020: A 44-Year-Old Woman With Chest Pain, Dyspnea, and Shock","volume":"383","author":"Newton-Cheh","year":"2020","journal-title":"N Engl J Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.03.005","article-title":"Kidney Disease Is Associated With In-Hospital Death of Patients With COVID-19","volume":"97","author":"Cheng","year":"2020","journal-title":"Kidney Int"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2020040419","article-title":"Acute Kidney Injury in COVID-19: Emerging Evidence of a Distinct Pathophysiology","volume":"31","author":"Batlle","year":"2020","journal-title":"J Am Soc Nephrol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.04.003","article-title":"Renal Histopathological Analysis of 26 Postmortem Findings of Patients With COVID-19 in China","volume":"98","author":"Su","year":"2020","journal-title":"Kidney Int"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2020.04.002","article-title":"Collapsing Glomerulopathy in a Patient With Coronavirus Disease 2019 (Covid-19)","volume":"5","author":"Larsen","year":"2020","journal-title":"Kidney Int Rep"},{"key":"B20","doi-asserted-by":"publisher","first-page":"gfab042","DOI":"10.1093\/ndt\/gfab042","article-title":"The Spectrum of Kidney Biopsies in Hospitalized Patients With COVID-19, Acute Kidney Injury, and\/or Proteinuria","volume":"12","author":"Ferlicot","year":"2021","journal-title":"Nephrol Dial Transplant"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2020060802","article-title":"Kidney Biopsy Findings in Patients With COVID-19","volume":"31","author":"Kudose","year":"2020","journal-title":"J Am Soc Nephrol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.05.025","article-title":"Thrombotic Microangiopathy in a Patient With COVID-19","volume":"98","author":"Jhaveri","year":"2020","journal-title":"Kidney Int"},{"key":"B23","doi-asserted-by":"publisher","first-page":"e20201766","DOI":"10.1542\/peds.2020-1766","article-title":"Pediatric Critical Care and COVID-19","volume":"146","author":"Gonz\u00e1lez-Dambrauskas","year":"2020","journal-title":"Pediatrics"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6932e2","article-title":"Covid-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020","volume":"69","author":"Godfred-Cato","year":"2020","journal-title":"MMWR Morbid Mortal Wkly Rep"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.10369","article-title":"Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-Cov-2","volume":"324","author":"Whittaker","year":"2020","journal-title":"JAMA"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1312353","article-title":"Syndromes of Thrombotic Microangiopathy","volume":"371","author":"George","year":"2014","journal-title":"N Engl J Med"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30062-4","article-title":"Fremeaux-Bacchi V and Loirat C.Haemolytic Uraemic Syndrome","volume":"390","author":"Fakhouri","year":"2017","journal-title":"Lancet (Lond Engl)"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2006080811","article-title":"Differential Impact of Complement Mutations on Clinical Characteristics in Atypical Hemolytic Uremic Syndrome","volume":"18","author":"Sellier-Leclerc","year":"2007","journal-title":"J Am Soc Nephrol: JASN"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2020003471","article-title":"Evidence of Thrombotic Microangiopathy in Children With SARS-CoV-2 Across the Spectrum of Clinical Presentations","volume":"4","author":"Diorio","year":"2020","journal-title":"Blood Adv"},{"key":"B30","doi-asserted-by":"publisher","first-page":"660","DOI":"10.3390\/toxins11110660","article-title":"Hemolysis Derived Products Toxicity and Endothelium: Model of the Second Hit","volume":"11","author":"Frimat","year":"2019","journal-title":"Toxins (Basel)"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.trsl.2020.04.007","article-title":"Complement Associated Microvascular Injury and Thrombosis in the Pathogenesis of Severe COVID-19 Infection: A Report of Five Cases","volume":"220","author":"Magro","year":"2020","journal-title":"Transl Res"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e140711","DOI":"10.1172\/jci.insight.140711","article-title":"The Complement System in COVID-19: Friend and Foe","volume":"5","author":"Java","year":"2020","journal-title":"JCI Insight"},{"key":"B33","doi-asserted-by":"publisher","first-page":"152001","DOI":"10.1016\/j.imbio.2020.152001","article-title":"Endothelial Injury and Thrombotic Microangiopathy in COVID-19: Treatment With the Lectin-Pathway Inhibitor Narsoplimab","volume":"225","author":"Rambaldi","year":"2020","journal-title":"Immunobiology"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.01753-18","article-title":"Complement Activation Contributes to Severe Acute Respiratory Syndrome Coronavirus Pathogenesis","volume":"9","author":"Gralinski","year":"2018","journal-title":"mBio"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.594849","article-title":"Complement Activation in Kidneys of Patients With Covid-19","volume":"11","author":"Pfister","year":"2020","journal-title":"Front Immunol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1172\/JCI83000","article-title":"Collectin-11 Detects Stress-Induced L-fucose Pattern to Trigger Renal Epithelial Injury","volume":"126","author":"Farrar","year":"2016","journal-title":"J Clin Invest"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.09.033","article-title":"Complement Activation Is a Crucial Driver of Acute Kidney Injury in Rhabdomyolysis","volume":"99","author":"Boudhabhay","year":"2021","journal-title":"Kidney Int"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.05.006","article-title":"Complement Activation in Patients With COVID-19: A Novel Therapeutic Target","volume":"146","author":"Cugno","year":"2020","journal-title":"J Allergy Clin Immunol"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1208981","article-title":"Terminal Complement Inhibitor Eculizumab in Atypical Hemolytic-Uremic Syndrome","volume":"368","author":"Legendre","year":"2013","journal-title":"N Engl J Med"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2019040331","article-title":"Use of Highly Individualized Complement Blockade Has Revolutionized Clinical Outcomes After Kidney Transplantation and Renal Epidemiology of Atypical Hemolytic Uremic Syndrome","volume":"30","author":"Zuber","year":"2019","journal-title":"J Am Soc Nephrol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.26355\/eurrev_202004_20875","article-title":"Eculizumab Treatment in Patients With COVID-19: Preliminary Results From Real Life ASL Napoli 2 Nord Experience","volume":"24","author":"Diurno","year":"2020","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2020.260117","article-title":"Complement C5 Inhibition in Patients With COVID-19 - A Promising Target","volume":"105","author":"Peffault de Latour","year":"2020","journal-title":"Haematologica"},{"key":"B43","doi-asserted-by":"publisher","first-page":"100590","DOI":"10.1016\/j.eclinm.2020.100590","article-title":"Eculizumab as an Emergency Treatment for Adult Patients With Severe COVID-19 in the Intensive Care Unit: A Proof-of-Concept Study","volume":"28","author":"Annane","year":"2020","journal-title":"EClinicalMedicine"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1007\/s40620-020-00858-2","article-title":"Eculizumab Treatment for Renal Failure in a Pediatric Patient With COVID-19","volume":"33","author":"Mahajan","year":"2020","journal-title":"J Nephrol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2021.680567\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,23]],"date-time":"2021-06-23T04:39:29Z","timestamp":1624423169000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2021.680567\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,23]]},"references-count":44,"alternative-id":["10.3389\/fimmu.2021.680567"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2021.680567","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,23]]},"article-number":"680567"}}