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He had severe abdominal pain and fever. It was not food poisoning.

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He had severe abdominal pain and fever. It was not food poisoning.

MIS was first described in a paper published in the British journal The Lancet in May 2020. A group of pediatricians described eight children, most of whom had some documented form of Covid-19, to a London hospital with persistent fever, abdominal pain and diarrhoea. His blood pressure was extremely low, and tests showed that his heart was not working properly. Doctors caring for these patients assumed it was an immune-system overreaction, triggered by infection with the coronavirus. Just a few weeks later, The Washington Post reported several cases of young adults who had been hospitalized with a similar illness, which eventually became known as MIS-A. Although it is unclear how even a mild infection with SARS CoV-2 can cause this life-threatening disorder, treatment with steroids, a class of drugs that suppress the immune system, has been shown to help.

Before suggesting this rare diagnosis, Bach reached out to a colleague, Dr. Bindu Balani, an infectious disease specialist at the hospital. “I admitted a patient…and found his case very complicated, so I was following him. I am wondering if he might have MIS-C,” she wrote. “Curious what you think Balani, who was on vacation with her family, didn’t have a computer right away and texted back, “He’s 33!” Still, she was curious and wanted to read the patient later that day. A computer was found. Her presentation was completely consistent with MIS. And she knew the syndrome was similar to that seen in adults. She called her colleague who had been assigned to the patient’s case and proposed the diagnosis, explaining that the ER The doctor had suggested this to him.

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MIS in children or adults can only be diagnosed if infection has been ruled out. In this patient’s case, he was on antibiotics for several days with no improvement, and none of the tests sent to look for other types of infection were positive. The possibility of MIS-A was discussed with all the specialists involved and the next day the patient was started on high-dose steroids.

The response was immediate. The fever and diarrhea both went away within 24 hours. He was able to get out of bed and walk. He was hungry – something he hadn’t felt for more than a week. He was discharged from the hospital a few days later.

Recovery was tough – both physically and mentally. It took him weeks to start feeling like himself again, and even now, 10 months later, he still feels out of breath when he hurries. But what’s worse is that he is left with scars on who he is. He described himself as a “textbook tough guy” to me. And he took care of himself – not a smoker, never used drugs, rarely drank. He tried to eat healthy food and be physically active. Despite all this, he came close to dying. And although his rational mind understood what had happened, there was a part of him that was still terrified – terrified that it happened in the first place, and terrified that it might happen again.


Lisa Sanders, MD, is a contributing writer for the magazine. His latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries”. If you have a resolved case to share, write it to [email protected]

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