PIMS: The Fatal Syndrome in Children, Associated With COVID 19

The Paediatric Multisystem Inflammatory Syndrome (called PIMS) has multiple names such as hyperinflammatory syndrome, Multisystem inflammatory syndrome in children (MIS-C), and Kawasaki Disease. This syndrome complex is associated with COVID-19 and is present mainly in children.

Children's Healthcare Canada created a webinar that provides an overview of the current epidemiology of COVID-19 with a focus on the newly defined PIMS. Here are some explanations that were given by the clinical presentation.

Relationship between PIMS and COVID-19

When all started in late December 2019 early January 2020, when a large number of pneumonia cases were reported from Wuhan, China, coronavirus was identified as a causative agent. On April 7, 2020, the first case of a child with Kawasaki Disease co-infected COVID-19 was reported. However, it wasn't all until April 27 that the medical community was alarmed about this.

When health authorities reported a cluster of seriously ill children presenting with shock and an inflammatory state, it was described as a Kawasaki-like disease because of the toxic shock syndrome.

On May 1, 2020, the Royal College of Paediatrics and Child Health, also known as RCPCH, coined the term Paediatric Multisystem Inflammatory Syndrome temporally associated with COVID-19. The institution provided a case definition and guidance.

Regarding the relationship between PIMS and COVID-19, the epidemiologic data from France public health suggested that PIMS occurred approximately four weeks following COVID-19 infection. The most affected population are 19 years old and younger.

Diagnostic Criteria

PIMS is suspected to be a post-infectious inflammatory syndrome associated with the COVID-19 pandemic. Is this Kawasaki Disease? Shock, myocarditis, and macrophage activation syndrome have all been described with Kawasaki Disease.

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The oral changes are described as a strawberry tongue, cracked lips, swollen lips, and large lymph nodes. Children often have a rash in their skin and Wobbler conjunctivitis present in both eyes. This entity is also described as a toxic shock-like syndrome.

PIMS has the following clinical manifestations: fever, rash, hypotension, vomiting, mucous membrane involvement, and Kawasaki shock syndrome. Kids have also presented gastrointestinal symptoms like vomiting or diarrhea and central nervous system such as disorientation or alterations in consciousness.

RCPCH states PIMS's case definition as "a child presenting with persistent fever, inflammation (neutrophilia, elevated CRP, and lymphopenia) and evidence of single multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder) with additional features. This may include children fulfilling full or partial criteria for Kawasaki disease."

PIMS Knowledge Could Save an Underage Life

In an interview with Paula Magazine, Lorena Navarrete, a Chilean mother, shared the painful testimony of her son's death for PIMS. Emilio was 16 years old, and despite her mother took great care of him, he got infected. Lorena rewinds that Emilio started feeling tired, and his legs hurt. A few days later, he wasn't able to walk.

Emilio had red spots all over his skin, fever, and his urine was brown. He started vomiting a lot too. The doctors suspected it was an allergy, but it wasn't; it was PIMS. After her son's death, Lorena realized that if she'd known what Emilio had, he could still be alive. For this reason, she decided to share her story. Lorena created a Facebook page to make this disease more known, and thanks to this, a father could save his son because they identified fast that he had PIMS, and the doctors had the time to save him.

PIMS is new, and although it mainly affects toddlers, children, and teens, there are also cases presented in adults. If parents knew more about this new disease, they could help save others' life.