Diagnosing the undiagnosed—what happened to PIMS?

Abstract

Adriel Chen and Devi Sridhar discuss the outbreak of Paediatric Inflammatory Multisystem Syndrome in 2020 and consider what lessons we can learn In mid-March 2020 and into April 2020, paediatric wards in England—usually full with children needing medical care due to respiratory diseases and other illnesses—were empty. The UK, and other countries in the world, were in a covid-19 lockdown. Schools were closing and children were staying at home and not mingling. The usual infectious disease mix that would result in children needing hospital care had a break. Paediatricians expected a quiet few months while NHS resources were directed towards the mounting wave of covid-19 hospital admissions, which were expected to be largely in the older and middle-aged population. And then incredibly unwell children started showing up in hospital.1 First one, then another one, and then several more. The children all had symptoms similar to the rare Kawasaki disease, an autoimmune disease, which can cause cardiac arrest and result in children being admitted to intensive care (ICU). Within the span of 10 days in April 2020, eight children were admitted to hospital in England, and one died.1 This sounded alarms. The children were previously fit and well, with no underlying illnesses. Paediatricians started discussing this and asked the worrying question: could this be a delayed presentation of covid-19? Most children were testing negative for SARS-COV-2 at the time of admission, but positive for the covid antibodies that noted previous infection. The children were older than those usually affected by Kawasaki disease, and most of them had caught covid five to six weeks prior.1 This alarmed physicians. Wasn’t covid-19 a disease that affected …