Initially, we thought COVID-19 was a viral disease that affected predominantly the elderly, who often had many comorbidities like lung disease, diabetes, and high blood pressure. We then discovered that COVID-19 also affects younger patients, without comorbidities, between the ages of 20-40, but in a different way (see MSR May 7, “COVID-19 may have a deeper, darker side.”
In this group of infected patients, the virus was causing blood clots that were leading to strokes, kidney damage and heart attacks. Now, there is emerging evidence that COVID-19 may have a different effect in even younger people, say, those under the age of 10.
In New York over the past several weeks, several children have developed a rare condition similar to a known condition called Kawasaki disease. Many of these kids tested positive for COVID-19, and doctors are suspecting a strong connection.
Kawasaki disease is a rare childhood disease that results from widespread inflammation of organs of the body. Some of the children have died. Doctors are referring to this new condition as “Pediatric Multisystem Inflammatory Syndrome.”
Children under the age of 10 were believed to represent only one percent of the recognized COVID-19 infections. “We don’t know everything about this virus,” Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, had said.
“And we’d really better be very careful, particularly when it comes to children. I think we’d better be careful that we are not cavalier in thinking that children are completely immune to the deleterious effects,” he said. Fauci commented on a rare inflammatory syndrome that has been linked to COVID-19, which has killed several children in New York and affected many others.
In Kawasaki disease, the cause has been unknown, but it is suspected to be directly caused by a viral or bacterial infection. Many doctors believe that it could be an over-response by the body’s immune system to a viral or bacterial infection.
Key features of Kawasaki disease
- A very high fever (over 102 degrees) lasting five or more days
- Red, itchy, bumpy rash all over the body,
- Red peeling rash in the bathing trunk area
- Red palms and soles
- Red, inflamed, cracked lips,
- Bright red swollen tongue (called a “strawberry tongue”)
- Red sore throat
- Red, bloodshot eyes
- Large lymph nodes in the neck
- Kawasaki disease occurs most commonly in those under the age of five, more common in boys and those of Asian descent. The disease is also called mucocutaneous lymph node syndrome because it affects the lymph nodes, skin, and mucous membranes in the mouth, throat and nose.
Other, later symptoms include:
- Joint pain
- Stomach pain
- Diarrhea and vomiting
- Peeling skin on the hands and feet
Like the older stroke victims, COVID-19 disrupts or causes significant inflammation of medium-sized blood vessels. Early diagnosis and aggressive treatment are essential to avoid long-term complications and even death in these children.
Many will need to be hospitalized in an intensive care setting and put on ventilators for heart and lung support in addition to aggressive medicinal treatment.
Unfortunately, the blood vessels most commonly affected in Kawasaki disease are the coronary vessels; that is, the vessels that supply blood to the heart.
Sometimes the blood vessels can weaken and balloon out, which is called a coronary artery aneurysm. The inflammation can also affect the heart itself. In fact, Kawasaki disease is the leading cause of heart disease in young people.
What to look for
The children have also developed symptoms associated with toxic shock syndrome, which have led some researchers to call this condition “Kawasaki-like shock syndrome associated with COVID-19”.
The key points here are:
Early recognition and treatment can be extremely beneficial
The syndrome is very, very rare
If your child develops a prolonged fever, rash in the bathing trunk area, large nodes in the neck and red, inflamed lips and tongue, red eyes, or abdominal pain, seek medical help immediately.
The one thing that doctors are discovering is that when it comes to COVID-19, we should expect the unexpected.
Charles E. Crutchfield III, MD is a board-certified dermatologist and clinical professor of dermatology at the University of Minnesota Medical School and a Benedict Distinguished Visiting Professor of biology at Carleton College. He also has a private practice, Crutchfield Dermatology in Eagan, MN.
He received his MD and Master’s Degree in molecular biology and
genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Minnesota Medicine recognized Dr. Crutchfield as one of the 100 Most Influential Healthcare Leaders in Minnesota. Dr. Crutchfield specializes in
skin-of-color and has been selected by physicians and nurses as one of the leading dermatologists in Minnesota for the past 18 years.
He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations and president of the Minnesota Association of Black Physicians. He can be reached at CrutchfieldDermatology.com or by calling 651-209-3600.