Paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 infection

Children are at lower risk than adults of catching and of developing severe illness with SARS‐CoV‐2 infection. However, a syndrome has emerged associated with SARS‐CoV‐2 infection in which children develop persistent fever and laboratory evidence of inflammation. An English case series described 58 children admitted to one of eight hospitals over 8 weeks who met the case definition for paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 (PIMS‐TS). ¹ Girls predominated (33, 57%). SARS‐CoV‐2 was detected by polymerase chain reaction in 15 (26%) of 58 and specific IgG antibody in 40 (87%) of 46 tested. Symptoms included fever (100%), abdominal pain (53%), diarrhoea (52%), vomiting (45%), rash (52%) and conjunctival infection (45%). Half (29/58) had shock (left ventricular myocardial dysfunction and raised troponin levels) requiring intravenous fluid resuscitation, inotropes and often mechanical ventilation (23/29, 79%). Thirteen children met diagnostic criteria for Kawasaki disease (KD); eight had coronary artery dilatation or aneurysms, of whom two had giant aneurysms. Children with PIMS‐TS (median age 9 years, interquartile range 5.7–14 years) were older than a comparison group of San Diego children with KD (median 2.7 years, interquartile range (IQR) 1.4–4.7 years) and Kawasaki shock (median 3.8 years, IQR 0.2–18 years) and had higher inflammatory markers (e.g. median serum C‐reactive protein = 229 (IQR 156–338), 67 (40–150) and 193 (83–237) mg/L, respectively). This study suggests, although there was some overlap with KD and Kawasaki shock, PIMS‐TS is a new distinct paediatric inflammatory disease.