Multi-System Inflammatory (Kawasaki-Like) Syndrome Associated with COVID-19

Early in the course of the COVID-19 pandemic, one of the only pieces of “good news” reported by medical literature and the lay press was that children, for the most part, did not appear to be as vulnerable to COVID-19 infection as adults. It was initially thought that perhaps children, when infected, developed milder cases which appear clinically like a minor upper respiratory infection.

In late April, however, the first published case of a Kawasaki-like disease associated with COVID-19 was described in Hospital Pediatrics when a 6-month-old in Northern California tested positive for COVID-19 after presenting with fever, blotchy rash, and mild respiratory symptoms.

Shortly thereafter, the New York State Department of Health reported 64 cases across the state and issued an advisory on what was termed the “Pediatric Multi-System Inflammatory Syndrome Temporally Associated with COVID-19.” On May 15, the World Health Organization (WHO) followed with a scientific brief which included adolescents as well as children.  WHO details the syndrome as a “multisystem inflammatory condition…features similar to those of Kawasaki disease and toxic shock syndrome. Case reports …acute illness accompanied by a hyperinflammatory syndrome, leading to multiorgan failure and shock…Children have been treated with anti-inflammatory treatment, including parenteral immunoglobulin and steroids.”

The American Heart Association also followed with a recommendation that children with Kawasaki-like symptoms including fever above 102°F to 104°F, swelling of the lymph node, and/or rash should be swiftly evaluated and cared for in hospitals with pediatric cardiac intensive care units, as required. Children with unexplained fever and elevated C- Reactive Protein (CRP) or white blood cell count should be carefully monitored.