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What To Know About Pediatric Multisystem Inflammatory Syndrome

May 14, 2020
By Margaret Chapman

In both Europe and the U.S., several children have been hospitalized with a rare illness that may be linked to COVID-19. Similar to Kawasaki disease or toxic shock syndrome, the condition, known as “pediatric inflammatory syndrome” or PMIS is causing heart and kidney failure in both young children and teenagers. New York Governor Andrew Cuomo, for instance, said that health officials are investigating more than 100 cases statewide, as well as three deaths, while 52 cases have been confirmed in New York City alone.

Here’s everything we know about the disease so far:

What are the symptoms?

Unlike COVID-19, PMIS does not cause respiratory symptoms like cough or shortness of breath. Instead, symptoms closely resemble a rare pediatric condition known as Kawasaki disease that causes inflammation of the arteries and can affect multiple organs, including the skin, blood vessels, kidneys, and heart. Commons symptoms of both PMIS and Kawasaki disease include:

  • High fever
  • Rash
  • Red eyes
  • Red or cracked lips
  • Red, swollen tongue resembling a strawberry
  • Swollen hands or feet
  • Skin peeling
  • Joint pain
  • Diarrhea
  • Abdominal pain
  • Blue or pale skin discoloration
  • Rapid breathing
  • Rapid heart rate
  • Lethargy

Unlike Kawasaki disease, which typically presents in children under 5 years old, cases of PMIS have been seen in children of all ages from infants to teenagers. Doctors have also noted that while shock is a rare complication in Kawasaki disease, many of the children with PMIS were in shock with very low blood pressure.

How is it linked to COVID-19?

The link between this inflammatory condition and COVID-19 is still unclear. Health officials are unsure what causes PMIS, but suspect it may be a post-infectious trigger. Of the patients in New York City, 25 tested positive for COVID-19 at the time of the symptoms, while 22 had COVID-19 antibodies suggesting they may have been infected earlier. Many experts believe a small number of children’s immune systems overreact in response to viral infections, leading to runaway inflammation as happens in PMIS. Others have suggested that children may be more susceptible to the condition because their immune systems are not yet fully developed.

How is PMIS treated?

Children with PMIS are being treated with different therapies to reduce inflammation, including intravenous immunoglobulin and steroids, as well as medications to protect vital organs. PMIS patients may also experience problems with their heart and other organs that require hospitalization and in rare cases, support in a pediatric intensive care unit.

How concerned should I be about my children?

While much is still unknown about PMIS, it is thought to be a rare complication related to COVID-19. Most children with confirmed COVID-19 have generally shown mild symptoms or had no symptoms at all. Serious COVID-19 cases are rare among young people, and inflammatory complications are even rarer. That being said, it’s important to adhere to social distancing orders and follow our general recommendations for protecting your child against COVID-19 to prevent further spread of the virus and life-threatening complications like PMIS.

If your child presents any of the symptoms listed above, please reach out to your child’s primary care provider. One Medical providers can be accessed 24/7 via our on-demand video visits and secure messaging platform on the One Medical app.

Symptoms that should be addressed immediately, and may warrant visiting an ER, include the following:

  • Any fever in children less than 12 weeks of age
  • Fever above 104°F
  • Fever for longer than 4 days in a child of any age
  • Fast breathing or trouble breathing
  • Bluish lips or face
  • Ribs pulling in with each breath
  • Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
  • Severe abdominal pain, diarrhea, or vomiting
  • Not alert or interacting when awake
  • Seizures
  • Fever or cough that improves but then returns or worsens
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Margaret Chapman, One Medical Provider

As a pediatrician, Peggy focuses on establishing a trusting and respectful relationship with parents and children to forge a therapeutic alliance. She believes preventive care and parent education are key to raising happy, healthy children-and she feels privileged to be part of the process. She enjoys working with children of all ages, from newborns through adolescents, and is especially interested in child behavior, child development, parenting, and ADHD. In her time off, Peggy enjoys walking, gardening, skiing, hiking, baking, and reading. She graduated from Rutgers New Jersey Medical School and did a chief residency in pediatrics at New York Presbyterian Hospital. She's board certified in pediatrics.

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