Four children treated for multisystem inflammatory syndrome at Cook Children’s Medical Center

From the Fort Worth City News Letter. Published on May 20, 2020.

A rare but serious health condition related to COVID-19 is now affecting children in North Texas. Since May 9, four patients have been treated at Cook Children’s Medical Center for multisystem inflammatory syndrome, or MIS-C. The children range in age from 6 to 14.

“All of these children presented to the hospital with symptoms that resembled a severe case of Kawasaki disease,” said Nicholas Rister, an infectious diseases physician at Cook Children’s.

Kawasaki disease is an illness that creates inflammation in blood vessels with no proven cause, but is generally thought to follow various infections after they have otherwise resolved. Rister said the patients with MIS-C arrived at Cook Children’s following exposure to COVID-19 and had symptoms including fever, abdominal pain and outward evidence of inflammation including diffuse rashes, conjunctivitis and swelling. In the more severe cases, evidence of multi-organ dysfunction including respiratory distress, low blood pressures, liver and kidney damage and altered mental status were also seen.

“Of particular concern to us is inflammation of the heart and surrounding major blood vessels which is also seen in Kawasaki’s disease. We have seen this same thing in several of these COVID-19 inflammatory disease patients,” Rister said. “Minimizing the degree of inflammation in these children, while providing supportive care for any organ damage, has been a key component of treatment.”

All four patients were tested for COVID-19. Three tests came back negative and one was positive.

“We believe all of these cases are related to COVID-19,” Rister said. “The three negative results are evidence of how far the infection had progressed, resulting in the inflammatory syndrome.”

Three of the patients have been released from the hospital. One remains in the pediatric intensive care unit.

In addition to the recent appearance of MIS-C cases, the infectious diseases team at Cook Children’s is also looking closely at increased reports of unexplained fevers in the area.

“We want parents to be aware of these cases as COVID-19 continues to spread in our community,” Rister said. “Unexplained fevers for several days and evidence of generalized inflammation may be signs of this illness.”

Symptoms of more severe MIS-C cases include severe abdominal pain, shock from low blood pressure, respiratory distress and lethargy. If a child exhibits any of these symptoms, seek emergency medical care immediately.

Less severe symptoms include fever, abdominal pain and rash. Caregivers should call a pediatrician if these symptoms appear, as they overlap with many other common infections and medical conditions. It is important for these children to be fully evaluated.