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Recent studies suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may precede the appearance of dysregulated immune responses, adopting the form of the multisystemic inflammatory syndrome in adults (MIS-A), as previously described in children (MIS-C).1 In this paper is presented the case of a 24-year-old Hispanic woman with a record of persistent positivity for lupus anticoagulant at moderate titers, without previous thrombotic or obstetric events, that was admitted to the hospital after 4 days of fever, headache, odynophagia, bilateral cervical painful lymphadenopathies, abdominal pain, nausea, vomiting, and diffuse exanthema. However, after having reasonably ruled out infectious and autoimmune pathology with normal laboratory, microbiologic, and imaging tests, and considering the recent SARS-CoV-2 infection, MSI-A was suspected and treated with a 2 mg/kg single dose of intravenous immunoglobulins and 1 mg/kg/day prednisone. The patient had experienced a recent SARS-CoV-2 infection, properly confirmed by a polymerase chain reaction (PCR) swab test 20 days before the admission. [Extracted from the article]

Multisystemic inflammatory syndrome in adults is a hyperinflammatory condition following (within 4-12 weeks) SARS-CoV-2 infection. Here, the dysregulation of the immune system leads to a multiorgan involvement often affecting the heart. Cardiac involvement in multisystemic inflammatory syndrome in adults has been described mainly in young men without other comorbidities and may present with different clinical scenarios, including acute heart failure, life-threatening arrhythmias, pericarditis, and myocarditis, with a nonnegligible risk of mortality (up to 7% of all cases). The heterogeneity of its clinical features and the absence of a clear case definition make the differential diagnosis with other postinfectious (eg, infective myocarditis) and hyperinflammatory diseases (eg, adult Still disease and macrophage activation syndrome) challenging. Moreover, the evidence on the efficacy of specific treatments targeting the hyperinflammatory response underlying this clinical condition (eg, glucocorticoids, immunoglobulins, and other immunomodulatory agents) is sparse and not supported by randomized clinical trials. In this review article, we aim to provide an overview of the clinical features and the diagnostic workup of multisystemic inflammatory syndrome in adults with cardiac involvement, highlighting the possible pathogenetic mechanisms and the therapeutic management, along with remaining knowledge gaps in this field.