This case series describes clinical characteristics, treatment, and outcomes of 17 previously healthy SARS-CoV-2-infected children and adolescents who developed an inflammatory phenotype related to COVID-19 but distinct from Kawasaki disease (KD) and toxic shock syndrome (TSS).
All patients were under 21 years of age, were admitted to Columbia University Irving Medical Center/NewYork-Presbyterian Morgan Stanley Children’s Hospital in New York City between April 18 and May 5, 2020, presented with a clinical syndrome characterized by prolonged fever, systemic inflammation, shock, end-organ dysfunction, or symptoms reminiscent of KD or TSS, and had evidence of recent SARS-CoV-2.
Among the 17 patients:
- 8 were male
- The median age was 8 years [range, 1.8-16 years])
- Most were white (n = 12) and were previously healthy (mild asthma in 3).
- All patients had fever (median duration, 5 days)
- 14 had gastrointestinal symptoms, with 1 showing acute ileocolitis on imaging
- Mucocutaneous findings were common (rash [n = 12], conjunctivitis [n = 11], and lip redness/swelling [n = 9]
- 3 patients were hypoxic at presentation
- 13 had shock
- 14 had abnormal chest radiograph findings, most commonly bilateral, interstitial opacities
- 8 met criteria for KD and 5 for incomplete KD
- 8 patients tested positive for SARS-CoV-2 by RT-PCR and the other 9 by serology
- Levels of inflammatory markers were elevated in all patients
- 16 had elevated serum IL-6 levels
- 15 patients required pediatric intensive care unit admission
By May 20, after a mean total length of hospital stay of 7.1 (range, 3-18) days, all patients had been discharged home with no fatalities. However, the occurrence of abnormal cardiac findings suggests the need for long-term surveillance.