Abstract
Multisystem inflammatory syndrome in adults (MIS-A) is a postacute hyperinflammatory condition associated with prior SARS-CoV-2 infection. While predominantly reported in children (MIS-C), MIS-A is increasingly recognized in adults and is characterized by multiorgan dysfunction, elevated inflammatory markers, and evidence of recent COVID-19. Timely diagnosis remains challenging due to clinical overlap with other infectious and inflammatory conditions. We report a case of a 36-year-old previously healthy male from Bihar, India, who presented with severe epigastric pain, progressive dyspnea, and systemic symptoms. Clinical examination revealed tachypnea, hypotension, pedal edema, ascites, and hemorrhagic rashes over the abdomen. Laboratory evaluation showed leukocytosis, thrombocytopenia, acute kidney injury, transaminitis, coagulopathy, markedly elevated inflammatory markers, and cardiac biomarkers. Chest imaging revealed bilateral subpleural opacities and mild pleural effusions, indicating pulmonary involvement. Despite a negative SARS-CoV-2 RT-PCR result, high antibody titers confirmed a recent COVID-19 infection. Imaging of the abdomen confirmed acute interstitial edematous pancreatitis. Extensive evaluation excluded tropical, autoimmune, and other infectious etiologies. The present case was managed with high-dose corticosteroids, vasopressors, mechanical ventilation, anticoagulation, and supportive therapy. He showed gradual improvement and was discharged after 6 weeks. MIS-A should be considered in patients with recent SARS-CoV-2 exposure presenting with systemic inflammation, including respiratory and extrapulmonary organ dysfunction. Early recognition and immunomodulatory therapy are essential for favorable outcomes.