ROCHESTER – In early May a young boy arrived at Golisano Children’s Hospital after being seen by his primary care physician for abdominal pain. The concern was that the patient was experiencing appendicitis, an inflammation of the appendix.
Doctors at Golisano determined that the problem was not abdominal pain, but an overall inflammation of the body that would present itself with red lips and eyes and through lab results.
The symptoms would lead doctors to conclude that the patient was experiencing a rare, but serious health condition affecting children that is associated with COVID-19.
In this case, the patient did very well and never needed advance care. He has continued to do well in the days since his discharge, said Dr. Jake Deines, an assistant professor of pediatrics, critical care, at Strong Memorial Hospital.
Deines and others doctors at University of Rochester Medical Center, of which the children’s hospital is a part, are working with colleagues around the country to gain an understanding of the condition, which has become known as Pediatric Multisystem Inflammatory Syndrome, or PMIS.
The condition causes inflammation the skin, eyes, blood vessels and heart and is an emerging concern among doctors and health officials.
“With the COVID pandemic, we’re learning as we go along. PMIS is something that’s relatively new to us,” Dr. Patrick Brophy, chair of pediatrics at UR Medicine’s Strong Memorial Hospital and physician-in-chief at Golisano Children’s Hospital, said during a Zoom video briefing on the condition.
Symptoms of PMIS may include prolonged fever – often the first symptom, abdominal pain, irritated eyes, and signs of inflammation such as rashes, red swollen hands, feet, lips and mouth.
The symptoms are not the typical pain or respiratory symptoms seen among adults diagnosed with COVID-19, Deines said.
Other symptoms may include changes in skin color, such as becoming pale, patchy and/or blue; difficulty feed infants or is too sick to drink fluids; trouble breathing or breathing very quickly, lethargy, irritability of confusion; or racing heart or chest pain.
Deines said doctors are seeing a lot of effects both in the abdomen and the heart. When the heart has inflammation “it sometimes can beat faster than it normally would, beat a little less efficiently than it normally would,” he said.
PMIS mimics symptoms similar to severe illnesses such as Kawasaki disease, an inflammatory disease that causes swelling and redness that most often affects kids younger than 5 years old, and toxic-shock syndrome, a complication of certain bacterial infections.
Health professionals initially thought the complications were predominantly in toddler to elementary school-age children. But in New York State the complications have affected young New Yorkers from infants through age 21, according to data presented during a May 13 briefing by Gov. Andrew Cuomo.
At least 16 other states and six European countries have reported similar cases in children, which does not present as a normal COVID-19, or respiratory case.
New York State is reporting 137 cases of PMIS as of May 19. At least three children’s deaths have been attributed to PMIS: a 5-year-old in New York City, a 7-year-old in Westchester County, and a teenager in Suffolk County.
Doctors at Golisano Children’s Hospital said they had treated about five children from the region, including a 10-year-old boy from Hornell, for the condition as of May 14.
Any child who displays symptoms of PMIS is also tested for COVID-19.
Dr. Brenda Tesini, assistant professor of infectious diseases and pediatrics at Strong, said it appears that PMIS happens after the COVID-19 infection has resolved. “So the child may never show those typical signs of the acute COVID infection, like we’ve seen in hospitalized adults,” she said.
The inflammatory conditions indicate that “the symptoms are really from their own immune response, and we think it’s from the immune system being overactive,” she said.
Symptoms may occur days to weeks after acute COVID-19 illness, according to reports from the United Kingdom, where a possible link was first reported between COVID-19 and serious inflammatory disease.
Brophy said UR Medical is working with multiple federal and state agencies to document PMIS and trying to identify all the symptoms and signs that bring children to the hospital with PMIS.
UR Medical is collecting data and working with the U.S. Centers for Disease Control, National Institute of Health, New York State and other pediatric hospitals.
“Really, we’re trying to nail down what it takes to make this diagnosis,” Brophy said. “I think the jury is still out on this as we start to understand the evolution of this particular inflammatory syndrome,” he said.
Doctors said it was to early to tell which children who have had COVID-19 may develop PMIS, or which demographics may be more susceptible to developing PMIS.
Tesini said it is important for parents to be vigilant about their children’s health. She said it is also important to continue to maintain social distancing and wear masks.
“All these measures have helped keep our rates of COVID infection in Monroe County and the Finger Lakes really fairly low,” Tesini said. “That’s what’s really preventing getting COVID to begin with and that’s what’s going to prevent children getting PMIS.”
Doctors at Golisano Children’s Hospital said it is important that children continue regular well-child visits and continue to receive scheduled vaccination.
“The more we do that, the less we have to worry about having other infections while we’re out in the face of a pandemic,” Brophy said.
“If you are concerned as a parent about your child, no matter where you are – urban, rural, wherever – please reach out to your physician or your provider and ask the questions you have to ask,” he said. “Please come and get care. Don’t ignore it.”