Kawasaki Disease and PIMS


“Don’t underestimate this virus,” warned New York Gov. Andrew Cuomo last week during a briefing.

Those words could not be more true as medical personnel continue to study COVID-19, how it is spread, what having antibodies to the virus may mean and who can be infected.

At the beginning of the pandemic it appeared that children were either not infected or affected. COVID-19 appeared to be a virus that was most dangerous for those over 65 years old and for those with underlying conditions, which appears to still be the case; however, there have been several stories of young, healthy people ending up in hospital ICUs with COVID-19.

Now there is information on how this virus may be affecting children.

“This April  Children’s Hospital Los Angeles [CHLA] has seen an increase in cases of typical and atypical Kawasaki disease [a rare condition affecting children] as compared to the previous years,” according to a CHLA release on May 13.

“Since April first, we have treated 16 cases of children who exhibited symptoms consistent with Kawasaki disease at Children’s Hospital Los Angeles,” said Jackie Szmuszkovicz, MD, pediatric cardiologist, Kawasaki disease specialist, CHLA. “None of them tested positive for acute COVID-19 disease.”

However, of this group of patients, the hospital examined antibodies in 14 patients looking for evidence of past infection. They found four were positive for antibodies and 10 were negative.

“The four positive results indicate that their inflammation may have been a late response to a recent past infection with SARS-Cov-2 [which causes COVID-19]. Our Kawasaki disease team is now following up with all of our patients who were diagnosed with Kawasaki disease since Jan. 1, to test them for SARS-CoV2 antibodies,” Szmuszkovicz said.

Another issue doctors are looking at is PIMS [Pediatric Inflammatory Multi-System Syndrome]. CHLA saw four patients with symptoms consistent with PIMS. Three patients, ranging in age from 8 months to 2 years old were discharged while one patient was admitted to the hospital in critical condition, as of May 13.

Michael Smit, MD, infectious disease specialist, said that all four children were treated at CHLA and did not test viral positive for active COVID-19 and were not contagious at the time they were at the hospital. The children were tested for antibodies.

“For these patients, a positive antibody test leads us to believe that these children had a prior infection of COVID-19 and that PIMS condition is likely a late inflammatory response to a previous acute infection,” Smit said.

Physicians are learning that “manifestations of PIMS can range broadly from a syndrome similar to Kawasaki disease to a syndrome more similar to toxic shock syndrome in some children,” Szmuszkovicz said.

CHLA has put a plan into place to test and treat children who have PIMS. They are sharing the information gathered with the 209 physicians currently affiliated with CHLA Network, as well as sharing information with community pediatricians, emergency department clinicians and the public. They also recently held a webinar that was attended by over 700 pediatricians and ER clinicians.

CHLA has alerted physicians and the public to symptoms to be looking for in children that includes a high fever that is persisting for four to five days or more with other symptoms that may include a rash, red cracked lips or red tongue, red eyes, swollen and/or red hands and feet, an enlarged lymph node in the neck, abdominal pain and/or diarrhea without another explanation and a fever for more than seven or more days in an infant, for which another explanation has not been identified.