Introduction: In 2020, several authors reported on the onset of multisystem inflammatory syndrome in children (MIS-C) (1-3), but the constant progression of the pandemic increases the number of reported cases in adults. It´s a life-threatening condition that occurs a few weeks after primary infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which often involves severe acute heart failure. We report about two cases of multisystem inflammatory syndrome in male adult (MIS-A) admitted to the Department of Intensive Cardiac Care, Arrhythmia and Transplantation Cardiology, University Hospital Centre Zagreb.

Case report: They are both younger males, ages 26 and 40, who recovered from SARS-CoV-2 infection in February and March 2021. Both had a mild clinical presentation that did not necessitate hospitalization or oxygen therapy. The younger patient’s medical history was marked by adiposity and arterial hypertension, whereas the other patient had no significant medical history. Both patients are admitted to the emergency department due to persistent fever, and preliminary blood tests reveal elevated inflammatory markers, ferritin, cardio selective enzymes, and the heart failure marker NT-proBNP. The 26-year-old patient’s condition rapidly deteriorated on the third day of hospitalization, with the development of chest pain, tachydyspnea, and hypotension. He was transferred to the tertiary center’s coronary intensive unit due to the development of cardiogenic shock, which was supported by vasopressors and inotrope (4), while the 40-year-old patient was moved due to suspected MIS-A. Both patients reported febrility (up to 39.5°C), dyspnea, reduced exercise tolerance, dry cough and diarrhea. The young patient reported chills and shivering, headache and nose secretions, while the other patient reported rashes on the forearms and distal part of the thighs without itching. Both patients had severely reduced global systolic function, with an left ventricular ejection fraction (LVEF) of about 20% and 30%, respectively. Following consultation with an infectious disease specialist, the protocol for the treatment of MIS-A was approached, and we began with two cycles of intravenous immunoglobulin, corticosteroids, and antibiotic therapy. Chronic heart failure therapy was gradually introduced into patients. Following the administration of this therapy, patients’ clinical and subjective conditions improve, with regression of inflammatory markers and cardio selective enzymes. Control echocardiography and magnetic resonance imaging were also performed, revealing that the young patient had fully recovered left ventricular function, with LVEF of 63% and the other patient having LVEF 53%. Patients were discharged home in good general condition on the 16th and 21st days of their hospitalization.

Conclusion: Multisystem Inflammatory syndrome in adult is rare but life-threatening complication of COVID-19 and it requires rapid diagnosis, hemodynamic support and specific treatment. The COVID-19 pandemic has highlighted the importance of nurses, but also the need for continuous education. The COVID-19 pandemic has highlighted the value of nurses, as well as the need for ongoing education. The nursing profession is rapidly evolving and does not solely focus on patient care; but even so, nurses are required to have knowledge about highly sophisticated treatments for patients, as well as the use of various technological achievements and innovations.