Children's Hospital LA Diagnoses Fourth Pediatric Patient with Disease Linked to COVID-19

Another case of a newly recognized pediatric disease associated in some cases with COVID-19 has been diagnosed in a fourth patient at Children's Hospital Los Angeles, the hospital said Wednesday during a teleconference.

The illness, named Pediatric Inflammatory Multisystem Syndrome, or PIMS, was first described by doctors in Europe and New York only last month. It is characterized as similar to the long known, but rare inflammatory disorder, Kawasaki disease.

Three of the young patients at CHLA, ages ranging from 8 months to 2 years, have now recovered and been able to return home, said Dr. Jacqueline Szmuszkovicz. A fourth child remains hospitalized in critical condition,
she said, citing privacy considerations in declining to discuss the case further.

In all four cases, serology testing found antibodies to the SARS-CoV-2 (COVID 19) virus, which indicates all had previously been infected.

"What we have learned is that the manifestation of PIMS can range broadly," Szmuszkovicz said. Symptoms include fever, rashes, abdominal pain, and extreme immune response. She likened its effect in some cases to toxic shock syndrome.

New York has been the US epicenter of PIMS diagnoses, with some 100 cases and three deaths. Diagnoses have also now been made in at least 19 states.

No PIMS cases had been reported on the west coast until CHLA disclosed its first three cases last week. An after the fact PIMS diagnosis of a child treated in March at Packard Children's Hospital in Palo Alto was made public earlier this week.

A spokesperson for UCLA Mattel Children's Hospital declined to comment on whether its doctors have yet seen any PIMS cases. Children's Hospital is now working with the Los Angeles Department of Public Health in an effort to determine whether there are any additional cases.

Thursday the Centers for Disease Control and Prevention issued diagnostic guidelines for the illness it is now calling Multisystem Inflammatory Syndrome in Children, or MIS-C.

The new guidelines draw a distinction with Kawasaki Disease that some physicians and researchers previously had noted.

"We need to be very careful that these are two different things
we are talking about, said Moshe Arditi, MD, Director of the Infectious and Immunological Diseases Research Center at Cedars-Sinai Medical Center. Dr. Arditi has done extensive research into Kawasaki disease. He says early data shows PIMS tends to afflict older children, beyond age 7, and be more severe.

"It's more like a toxic shock syndrome. It has an incredibly severe myocardial dysfunction, brings you into shock. And you need to be in the intensive care unit in a majority of these cases," Arditi said during an interview Wednesday.

In severe COVID cases among adults, there is sometimes a hyper immune response, called a "cytokine storm," that causes inflammation and organ damage.

"Perhaps this is a version of it that we are seeing in children," Arditi said.

He emphasizes the difference between Kasawaki and PIMS is goes beyond whether or not the patient is found to have COVID antibodies. At this early stage, he suspects that some Kawasaki illnesses are being misdiagnosed as PIMS in cases where the patient had, by coincidence, been infected with COVID.

Arditi said the suspected connection of PIMS to Covid-19 remains unproven, noting that in some PIMS cases, serology testing did not find COVID antibodies.

Cedars has seen one Kawasaki case this year, but as of yet, no PIMS cases, he said.

Since April 1, CHLA has treated 16 patients with symptoms similar to Kawasaki disease, a much higher number than in years past. Covid antibodies were not found in ten of the 14 who were tested.

The director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, cited PIMS Tuesday while testifying to a US Senate committee, urging caution in returning to school.

"We don't know everything about this virus and we really better be pretty careful, particularly when it comes to children," Fauci said.

Children account for only a tiny percentage of the patients who have tested positive for COVID, and only a tiny percentage of those are believed to have contracted PIMS.

But whenever a child displays a high fever and other symptoms, a pediatrician should be consulted, Arditi said.