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Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City

Educational Objective
To understand how multisystem inflammatory syndrome in children and adolescents is related to COVID-19

Severe coronavirus disease 2019 (COVID-19) has been reported rarely in children.1,2 International data suggest the development of a proinflammatory syndrome with features of Kawasaki disease (KD) or toxic shock syndrome (TSS) in children, possibly related to COVID-19.3

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Article Information

Corresponding Author: Eva W. Cheung, MD, Divisions of Cardiology and Critical Care, Department of Pediatrics, Columbia University Irving Medical Center, 3959 Broadway, CHN 2 North, New York, NY 10032 (ec2335@cumc.columbia.edu).

Accepted for Publication: May 27, 2020.

Published Online: June 8, 2020. doi:10.1001/jama.2020.10374

Author Contributions: Drs Cheung and Zachariah had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Cheung and Zachariah contributed equally to the authorship of this article.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Cheung, Zachariah, Gorelik, Boneparth, Orange, Milner.

Drafting of the manuscript: Cheung, Zachariah, Gorelik, Boneparth, Milner.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Cheung, Zachariah.

Administrative, technical, or material support: Zachariah, Gorelik, Orange.

Supervision: Kernie, Orange, Milner.

Conflict of Interest Disclosures: Dr Orange reported receiving personal fees from ADMA Biologics, CSL Bhering, Gigagen, Grifols, and Takeda. No other disclosures were reported.

Additional Contributions: Candace Johnson, MD, Kara Gross-Margolis, MD, Irene Lytrivi, MD, Angela Chan, MD, and Brian Jonat, MD, MPH (Department of Pediatrics, Columbia University Irving Medical Center), contributed to data collection and analysis and editing assistance for this letter. Eldad A. Hod, MD (Department of Pathology and Cell Biology, Columbia University Irving Medical Center), contributed to data collection and writing of the manuscript. None of these individuals were compensated for their contributions.

References
1.
Castagnoli  R , Votto  M , Licari  A ,  et al.  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review.   JAMA Pediatr. Published online April 22, 2020. doi:10.1001/jamapediatrics.2020.1467PubMedGoogle Scholar
2.
Tagarro  A , Epalza  C , Santos  M ,  et al.  Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain.   JAMA Pediatr. Published online April 8, 2020. doi:10.1001/jamapediatrics.2020.1346PubMedGoogle Scholar
3.
Riphagen  S , Gomez  X , Gonzalez-Martinez  C , Wilkinson  N , Theocharis  P .  Hyperinflammatory shock in children during COVID-19 pandemic.   Lancet. 2020;395(10237):1607-1608. doi:10.1016/S0140-6736(20)31094-1PubMedGoogle ScholarCrossref
4.
McCrindle  BW , Rowley  AH , Newburger  JW ,  et al; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention.  Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association.   Circulation. 2017;135(17):e927-e999. doi:10.1161/CIR.0000000000000484PubMedGoogle ScholarCrossref
5.
Li  Y , Zheng  Q , Zou  L ,  et al.  Kawasaki disease shock syndrome: clinical characteristics and possible use of IL-6, IL-10 and IFN-γ as biomarkers for early recognition.   Pediatr Rheumatol Online J. 2019;17(1):1. doi:10.1186/s12969-018-0303-4PubMedGoogle ScholarCrossref
6.
Chen  G , Wu  D , Guo  W ,  et al.  Clinical and immunological features of severe and moderate coronavirus disease 2019.   J Clin Invest. 2020;130(5):2620-2629. doi:10.1172/JCI137244PubMedGoogle ScholarCrossref
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