Multi-system Inflammatory Syndrome & Its Possible Link to COVID-19 in Children

We know that COVID-19 causes severe disease mostly in older adults and in those with underlying health problems. Fortunately, children for the most part have been spared the worst of the illness.

However, over the past couple weeks there have been reports both in Europe and in the United States of clusters of children presenting with an inflammatory syndrome affecting multiple organ systems. Affected children have symptoms that are seen in other severe systemic illnesses including Kawasaki disease, toxic shock syndrome, and bacterial sepsis, among others.

What is Pediatric Multi-system Inflammatory Syndrome?

Multi-system inflammatory syndrome is a condition caused by inflammatory responses in the body. It may occur in response to a viral illness. Some children have reportedly had mild and more slowly developing symptoms, while others have had a more rapid course with severe complications.

Doctors are still working to understand the full range of symptoms caused by the illness. Common symptoms that have been reported include:

Fever higher than 101F that lasts for a few days

Rash over the whole body

Bright red eyes

Swollen hands and feet and red palms and soles

Red surfaces of the inside of the mouth

A swollen lymph node or gland on one side of the neck

Red chapped lips that may crack and bleed

Breathing difficulty or gasping breaths

Confusion or disorientation

Severe headache

Extreme weakness and/or inability to walk or stand

Excessive irritability or lethargy (not responding appropriately, not fully awakening)

Joint pain or swelling

Vomiting and diarrhea

What is the link between COVID-19 and Pediatric Multi-system Inflammatory Syndrome?

In short – it’s not clear. Doctors in hospitals across the country have been seeing an uptick in pediatric multi-system inflammatory syndrome shortly after the pandemic peaked.

“Blood tests show that there is marked systemic inflammation in affected children to a level not usually seen in most routine childhood illnesses,” says Kevin Slavin, M.D. director of quality and a pediatric infectious disease specialist at Joseph M. Sanzari Children’s Hospital.

It’s unclear what causes this condition, but Dr. Slavin says that viral infections can sometimes spur the illness. That’s where COVID-19 comes in.

“While COVID-19 has only been detected in a minority of pediatric multi-system inflammatory syndrome cases seen at Hackensack Meridian Health, some children have tested positive for antibodies indicating they may have been infected at some point,” says Aryeh Baer, M.D., also a pediatric infectious disease specialist at Joseph M. Sanzari Children’s Hospital. “The timing of this unusual cluster of ill children, in the midst of the current global pandemic, raises the possibility that this may be a syndrome caused by the immune response to this new virus.”

However, it’s important to note that while both may suggest evidence of a COVID-19 infection, it doesn’t prove that it is the cause of the inflammatory response, adds Dr. Slavin.

What are the long-term concerns?

“At this time, we do not know if the inflammation causes long-term health consequences,” says Dr. Slavin.

According to Dr. Slavin, it does seem that early recognition of the syndrome and anti-inflammatory treatment can lead to improvement that may decrease, or even prevent, the risks of long-term damage from the inflammation.

When should I be concerned?

There are many unanswered questions about these recently reported cases and their possible association with COVID-19, as well as their similarities to other inflammatory syndromes including Kawasaki disease. Doctors across the globe continue to study cases and share information readily.

“For now, if the child looks particularly sick, they should go to a pediatric emergency department or activate emergency services,” suggests Dr. Slavin.

If your child doesn’t appear sick, but you have concerns, call your doctor and monitor your child’s symptoms. If they get worse, take your child to the nearest emergency department or call 9-1-1.

 Next Steps & Resources:

Find a pediatrician near you.

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The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.