COVID-19 and Pediatric Inflammatory Multi-System Syndrome (PIMS)

We know that as a parent of a child with IBD, your primary concern is to keep your child safe and healthy. With a growing number of positive cases of COVID-19 in the United States, the good news is that the impact on children remains low, and many who do have the virus experience mild symptoms or none at all. However, recent reports about a condition called pediatric inflammatory multi-system syndrome (PIMS) may add some uncertainty as you continue to manage your child’s IBD. Staying informed will help you have conversations with your doctor and make the best decisions for your child's care.


About PIMS | Kawasaki disease | Toxic shock syndrome | PIMS diagnosis | IBD and PIMS risk | PIMS and IBD symptoms | What to do if your child shows signs of PIMS Treatment

What is pediatric inflammatory multi-system syndrome (PIMS)?

Pediatric inflammatory multi-system syndrome, or PIMS, is a condition that involves inflammation in organ systems and other symptoms that require immediate care and treatment. Cases of PIMS have been recently reported in Europe, and are also being observed among children and young adults in the United States.1 Of these recent cases, some of the children had the antibodies of SARS-CoV-2, suggesting a potential link to the virus, however doctors and scientists are still learning more as further information is reported. 

What are the symptoms of PIMS?

Symptoms of PIMS may resemble Kawasaki disease as well as toxic shock syndrome. Similarities may also be seen with a medical issue called cytokine storm, where the body produces high levels of inflammatory signals, determined through laboratory tests.

Symptoms of PIMS that have been observed can include:

  • Persistent fever
  • Elevated inflammatory markers (observed through blood testing)
  • Additional symptoms commonly associated with toxic shock syndrome, such as:
    • Vomiting
    • Diarrhea
    • Low blood pressure
    • Rash, confusion and muscle aches
  • Additional symptoms commonly associated with Kawasaki disease such as:
    • Rash
    • Swelling and redness in hands and feet
    • Redness in the eyes,
    • Swollen lymph glands in the neck
    • Irritation in the mouth, lips and throat

Only the severe cases of PIMS have been identified, but those that have been reported required respiratory and/or cardiac support.

It is important to note that PIMS is not the same as Kawasaki disease, or toxic-shock syndrome, but there are similarities that have been observed, which has guided diagnostic and treatment decisions. Research is needed to help us better understand the recent development of PIMS and its impact on children. 

Parents and patients should not self-diagnose these conditions and should not take any extra medication without talking to their doctor.

For more information:

What is Kawasaki disease?

Kawasaki disease, also known as mucocutaneous lymph node syndrome, is a condition that affects the body’s cardiovascular system, and while rare, has a higher incidence among children under five years of age. This disease can cause damage to the blood vessels, and the heart muscle2. Complications, such as potential for blood clotting and heart failure, can occur. While issues with the heart can be resolved in five to six weeks, damage to the coronary arteries can continue in some cases, therefore getting a diagnosis promptly is very important so that a child can receive treatment as soon as possible.

The American Heart Association lists the following symptoms of Kawasaki disease, which may include:

  • Fever (ranging from 101 to above 104) 
  • Rash on back, chest, and abdomen 
  • Swelling and redness in hands and feet 
  • Redness in the eyes
  • Swollen lymph glands in the neck 
  • Irritation and swelling of the mouth, lips, and throat

Resources: 

What is Kawasaki Disease? - American Heart Association

About Kawasaki Disease - CDC

Kawasaki Disease & COVID-19 FAQ’s - Kawasaki Disease Foundation

What is toxic shock syndrome?

Toxic shock syndrome is a serious complication caused by toxins made by certain types of bacteria. Possible signs and symptoms of toxic shock syndrome include:

  • A sudden high fever
  • Low blood pressure
  • Vomiting or diarrhea
  • A rash resembling a sunburn, particularly on your palms and soles
  • Confusion
  • Muscle aches
  • Redness of your eyes, mouth and throat
  • Seizures
  • Headaches

Resources:

Toxic shock syndrome - MedlinePlus 

How is PIMS diagnosed?

Currently, the diagnosis of PIMS may require an initial screening, careful examination of the child and his or her symptoms, and ruling out other diseases or infections. If your child has an in-person consultation, their healthcare team may also request an electrocardiogram, or echocardiogram to examine the heart. Doctors may also include testing for SARS-CoV-2 antibodies as more investigation and information is gathered about this condition, and who may be impacted.

Is a child with IBD more at risk for PIMS?

There is still more to learn about COVID-19, PIMS, and its effect on children, however current cases have not been limited to children with underlying chronic conditions. There is no evidence to suggest that children with Crohn’s disease or ulcerative colitis are at higher risk of SARS-CoV-2-associated PIMS, however, parents and caregivers of children with IBD should continue to follow CDC guidelines to limit risk of exposure to SARS-CoV-2. 

How can I tell the difference between PIMS and IBD symptoms?

The symptoms of IBD may include diarrhea, abdominal pain, and vomiting, which are similar to the symptoms observed among patients with PIMS. Although this can add a level of uncertainty as you adjust to managing your child’s health during this time, you should always seek the advice and recommendations of your healthcare team. Make note of any changes in your child’s symptoms, including the presence of a persistent fever, or changes in their gastrointestinal (GI) symptoms and contact your child’s doctor immediately. 

What should I do if I suspect my child has PIMS?

Contact your child’s healthcare team immediately if you suspect your child has PIMS. Your doctor and healthcare team may conduct a screening (series of questions) to help assess your child’s health and recommend next steps. Depending on your child’s individual situation, your doctor may advise a visit with your child's healthcare team, testing, or going to the emergency department. If your child is experiencing serious illness, seek attention from your nearest emergency department immediately. Call 911 if your child is experiencing the following symptoms:

  • Difficulty breathing 
  • Chest pain
  • Extreme lethargy (lack of energy)
  • Altered mental status (confusion, delayed response)
  • Concern for dehydration

How are PIMS, Kawasaki disease and toxic shock syndrome treated?

In reported cases, PIMS has shown a resemblance to Kawasaki disease and toxic shock syndrome, and as such, may be treated similarly. However, this may change as more is learned; it's especially important to talk to your doctor about a thorough screening and examination to ensure the best treatment approach for your child.

Kawasaki disease is initially treated at the hospital due to potential complications, and can include:

  • Intravenous immunoglobulin (a type of protein)
  • High dose aspirin (under the supervision of the medical team)
  • In cases where these medications above are ineffective, children may be given steroids, or other immunosuppressing medication. The medication options will depend on their response to the intravenous immunoglobulin and other individual factors.3

Treatment for toxic shock syndrome includes antibiotics. Other medications may be used to manage the effects of this condition on the body.

Children may be need to stay at the hospital for a few days, to weeks depending on their health status. Their care may include a multi-disciplinary team, including pediatricians and gastroenterologists, infectious disease specialists, cardiologists, and others depending on any specific health concerns.

Be sure to let any treating physician and hospital care team know the IBD medications, nutritional supplementation, or other medications (and doses) that your child may be taking.

Last updated May 2020

 

References

1 Pediatric Intensive Care Society. PICS Statement: Increased number of reported cases of  novel presentation of multi-system inflammatory disease. April 27, 2020. Available at https://picsociety.uk/wp-content/uploads/2020/04/PICS-statement-re-novel-KD-C19-presentation-v2-27042020.pdf

2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374576/

3 American Heart Association Scientific Statement. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease A Scientific Statement for Health Professionals From the American Heart  Association. April, 24, 2017.