Doctors beware: Some young coronavirus patients seem well, then rapidly deteriorate, New York hospital warns

A case series released by a New York hospital urges emergency doctors to stay on high alert for MIS-C, the coronavirus-linked inflammatory condition, even in children who appear well.

Weeks after a COVID-19 infection, some healthy children are becoming critically ill due to a rare, inflammatory response. The U.S. Centers for Disease Control and Prevention coins the illness as multi-system inflammatory syndrome in children, or MIS-C.

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In a study, published May 23 in The American Journal of Emergency Medicine, researchers from Mount Sinai School of Medicine detailed some of the earliest MIS-C cases.

A case series released Mount Sinai doctors is being used to urge emergency physicians to maintain high suspicion for MIS-C, the coronavirus-linked inflammatory condition, even in children who appear well. (iStock)

A case series released Mount Sinai doctors is being used to urge emergency physicians to maintain high suspicion for MIS-C, the coronavirus-linked inflammatory condition, even in children who appear well. (iStock)

In the case series, four previously healthy kids tested negative for COVID-19 through a nasal swab test, though serologic antibody testing revealed their exposure to the disease.

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The children showed the rare, inflammatory response at Mount Sinai’s Pediatric Emergency Department. All four of them required admission to Mount Sinai’s Pediatric Intensive Care Unit.

“Our case series underscores the need for emergency physicians to maintain a high clinical suspicion for COVID-19 post-infectious cytokine release syndrome, even in children who initially appear well,”  said Dr. Temima Waltuch, a pediatric emergency medicine fellow at the Icahn School of Medicine at Mount Sinai, in a press release.

A study author says "the syndrome appears to be its own entity but patients show symptoms similar to Kawasaki disease, with a fever, rash and conjunctivitis." (iStock)

A study author says "the syndrome appears to be its own entity but patients show symptoms similar to Kawasaki disease, with a fever, rash and conjunctivitis." (iStock)

“This syndrome appears to be its own entity but patients show symptoms similar to Kawasaki disease, with a fever, rash and conjunctivitis,” Waltuch wrote.

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The doctor said patients then deteriorate in a way similar to that seen in toxic shock syndrome.

“Vigilance in assessing for these symptoms will be critical to help identify these patients early in the clinical course,” she said.

The children in the case studies were aged 5 to 13, and all showed an exaggerated cytokine storm. To reduce the inflammation, doctors treated them with intravenous immunoglobulin and tocilizumab, an immunosuppressive drug typically used in treating rheumatoid arthritis.

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It is important for parents to watch for signs and symptoms in their children and seek immediate care if they are concerned, the doctor said.

Though MIS-C is rare, doctors say parents should monitor their children for associated symptoms. (iStock)

Though MIS-C is rare, doctors say parents should monitor their children for associated symptoms. (iStock)

Study co-author Dr. Jennifer E. Sanders, assistant professor of emergency medicine and pediatrics at the Icahn School of Medicine at Mount Sinai, offered advice to emergency doctors.

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“Be cautious of patients who at first appear well as they may quickly decompensate and require fluid resuscitation, pressor support for blood pressure control, and possibly intubation,” Sanders said, among other guidance.