Submitted by Mitchel B. Alpert, M.D., FACC, FAAP

Pediatric Multi-system Inflammatory Syndrome (PMIS) has been gaining great attention in the media in the last few weeks.

In my office, I find parents often asking me about this syndrome even though the reason for the visit is usually quite different. Therefore, I felt I would try to separate fact from fiction to this new and in many ways still unknown entity.

During the current COVID-19 epidemic, the general understanding is that children are often spared of any major illness or prolonged effect from COVID-19. This remains essentially correct. Most children who contract COVID-19 are asymptomatic and don’t even realize they have contracted the illness though they are quite capable of passing COVID-19 to others, particularly older adults. What happens with PMIS is that long after the initial illness has passed, even if asymptomatic, the body will react to the illness forming antibodies and this is where the problem occurs with PMIS.

It has to be emphasized that PMIS is very rare, and the odds of any particular child ever contracting PMIS is extremely unlikely. It is imperative that this fact be kept in mind as the illness is described.

When forming an antibody response to COVID-19, an extremely small number of children will develop what looks like Kawasaki Disease (KD). In fact, a just released study shows that KD in the last few months has been 30 times more frequent than in previous years during the same time period. Clearly what is occurring is more than the average KD that is seen in a Pediatrician’s office.

While PMIS is extremely rare there is another subset of the syndrome where the children become acutely ill requiring a Pediatric ICU admission. These children can have what resembles toxic shock syndrome requiring multiple medications to keep the blood pressure in acceptable limits. Also, as the name multisystem implies other organ systems can be involved. Blood work in these patients is very different than what is seen in KD patients. In many ways, these patients ironically are the easiest to diagnose. The common thread when making the diagnosis of PMIS is that most, but not all, patients will test positive for antibodies to the COVID-19 virus.

I want to emphasize once again that though PMIS is in the media constantly, it is actually very rare and the acute form needing a Pediatric ICU admission is even more rare. In New Jersey thus far, every patient has made a recovery and no patient has passed away. This problem clearly is treatable.

My advice for those having more questions, is to speak to your Pediatrician or other primary care providers. They are well aware of the PMIS diagnosis and are on the lookout for it. One thing however does seem certain. Any child during this time period diagnosed with KD should be worked up under the assumption that the patient might have the COVID-19 variety of KD.

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Mitchel B. Alpert, M.D., FACC,FAAP

Director of Pediatric Cardiology

K. Hovnanian Children’s Hospital

Jersey Shore University Medical Center

Hackensack Meridian Health