{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T19:21:10Z","timestamp":1773775270661,"version":"3.50.1"},"reference-count":13,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T00:00:00Z","timestamp":1730764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: SARS-CoV-2 infection can lead to a potentially life-threatening condition known as SARS-CoV-2-associated multisystem inflammatory syndrome in children (MIS-C), which differs from the severe lung disease and thrombotic complications commonly seen in adults. Recently, similar cases have been identified in adults, characterized by a clinical multisystem inflammatory syndrome referred to as MIS-A, which can emerge as a late and severe complication of SARS-CoV-2 infection. Case Presentation: We report two cases of MIS-A that were recently admitted to our hospital. Both patients developed a severe multisystem inflammatory syndrome despite experiencing only mild SARS-CoV-2 infection. Key clinical features in both cases included significant systemic inflammation, prominent cardiac involvement, and thrombocytopenia. Prior SARS-CoV-2 infection was confirmed through serological testing. Treatment protocols for MIS-C, including steroids and immunoglobulins, proved effective for both patients. Conclusions: Clinicians should remain vigilant for MIS-A in the context of ongoing SARS-CoV-2 infection worldwide. This infection, even when presenting with mild or no symptoms, can progress to a life-threatening hyperinflammatory syndrome with cardiac implications if not promptly recognized and treated.<\/jats:p>","DOI":"10.3390\/jcm13226632","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T06:30:48Z","timestamp":1730788248000},"page":"6632","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Multisystem Inflammatory Syndrome of Adults (MIS-A) as Delayed Severe Presentation of SARS-CoV-2 Infection: A Description of Two Cases"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6930-7260","authenticated-orcid":false,"given":"Bernd","family":"Raffeiner","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bolzano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Rojatti","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bolzano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Tr\u00f6binger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bolzano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana Manuela","family":"Nailescu","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bolzano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2553-9147","authenticated-orcid":false,"given":"Leonardo","family":"Pagani","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Central Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), 39100 Bolzano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3862","DOI":"10.1136\/bmj.m3862","article-title":"Virology, transmission, and pathogenesis of SARS-CoV-2","volume":"371","author":"Cevik","year":"2020","journal-title":"BMJ"},{"key":"ref_2","unstructured":"The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group (2020). Association Between Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19. JAMA, 324, 1330\u20131341."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1111\/jth.14817","article-title":"Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy","volume":"18","author":"Tang","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_4","first-page":"51","article-title":"Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation","volume":"38","author":"Radia","year":"2021","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.15585\/mmwr.mm6940e1","article-title":"Case Series of Multisystem Inflammatory Syndrome in Adults Associated with SARS-CoV-2 Infection\u2014United Kingdom and United States, March\u2013August 2020","volume":"69","author":"Morris","year":"2020","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1007\/s00296-021-04843-1","article-title":"Multiple system inflammatory syndrome associated with SARS-CoV-2 infection in an adult and an adolescent","volume":"41","author":"Bastug","year":"2021","journal-title":"Rheumatol. Int."},{"key":"ref_7","first-page":"598","article-title":"First Cases of Multisystem Inflammatory Syndrome following SARS-CoV-2 infection in Adults in Germany","volume":"146","author":"Rieper","year":"2021","journal-title":"Dtsch. Med. Wochenschr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"eabf7570","DOI":"10.1126\/sciimmunol.abf7570","article-title":"Deep immune profiling of MIS-C demonstrates marked but transient immune activation compared to adult and pediatric COVID-19","volume":"6","author":"Vella","year":"2021","journal-title":"Sci. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1017","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":"ref_10","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1056\/NEJMoa2104840","article-title":"Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination","volume":"384","author":"Greinacher","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zahornacky, O., Porub\u010din, \u0160., Rovnakova, A., and Jarcuska, P. (2023). Multisystem Inflammatory Syndrome in Adults Associated with Recent Infection with COVID-19. Diagnostics, 13.","DOI":"10.3390\/diagnostics13050983"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"195","DOI":"10.3390\/biomed3010016","article-title":"Multisystem Inflammatory Syndrome in Adults (MIS-A) and SARS-CoV-2: An Evolving Relationship","volume":"3","author":"Worku","year":"2023","journal-title":"BioMed"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.clicom.2024.04.003","article-title":"Post COVID-19 multisystem inflammatory syndrome in adults (MIS-A): Underappreciated in international health? A Case Series","volume":"5","author":"Koning","year":"2024","journal-title":"Clin. Immunol. Commun."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6632\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:26:21Z","timestamp":1760113581000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6632"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,5]]},"references-count":13,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13226632"],"URL":"https:\/\/doi.org\/10.3390\/jcm13226632","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,5]]}}}