The young patients began showing up in the emergency room with strange symptoms about two weeks ago.
Red eyes. Fevers that lasted for days. Low blood pressure.
At least five children, ages 6 to 12, have arrived at Bristol-Myers Squibb Children’s Hospital in New Brunswick since late April with symptoms mirroring Kawasaki disease, an illness that causes inflammation in blood vessels. They soon were treated in the intensive care unit for serious cardiac issues.
They are among the first New Jersey cases of a rare and potentially deadly pediatric inflammation syndrome being investigated for its links to the coronavirus, according to state health officials.
The five children — who all tested positive for the coronavirus — came to the hospital with signs of cardiac failure, according to Dr. Jennifer Owensby, a pediatric intervention specialist at Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital.
Three remain in intensive care, and two have been discharged.
“We’ve known about Kawasaki’s disease for a long time in pediatrics. It’s not common, but it’s not exceptionally rare,” Owensby said. “I think what’s new now is that we are seeing an association with COVID-19, similar to what they’re seeing in New York and Europe.”
The New Jersey Department of Health first acknowledged cases on Wednesday, although it’s unclear how many have been identified in the state.
“The New Jersey Department of Health has been alerted to this pediatric inflammatory syndrome and is aware of potential cases in New Jersey,” health department spokeswoman Donna Leusner said in a statement. “We are in the process of getting additional guidance from the CDC, including the criteria for defining a case.”
The multi-system inflammation syndrome has already been found in more than 60 children in New York state about a week after European health officials warned doctors to look out for it.
“We’re paralleling what happened in New York,” Owensby said. “Kawasaki’s has been around for a long time, but associating it with COVID is definitely new.”
Kawasaki’s disease mainly affects the coronary arteries, said Dr. Patricia Whitley-Williams, professor of pediatric infectious disease at Rutgers RWJ Medical School and president-elect of the National Foundation for Infectious Disease. The five children in New Jersey have had carditis — inflammation of the heart — and cardiomyopathy, a disease of the heart muscle that hinders its ability to pump blood.
“Their hearts are inflamed,” Whitley-Williams said. “When the heart goes to pump, the muscle cannot pump efficiently. If you don’t pump blood out to the rest of your body, your blood pressure goes down. These patients come in in shock with low blood pressure.”
On Tuesday, New Jersey Health Commissioner Judith Persichilli said she had not received any reports of multi-symptom inflammatory disease in the state during the governor’s daily coronavirus media briefing.
But that had changed by Wednesday afternoon.
New Jersey has identified at least 131,890 cases and 8,549 deaths related to COVID-19 in a state of 9 million residents. But there have been no deaths reported among people 16 and younger.
While infected adults often battle pneumonia and chest tightness, these five children are suffering cardiac issues.
“The lungs are not the problem. It’s the heart,” Whitley-Williams said. “The UK reported this and referred to it as the inflammatory syndrome. We’re talking about the same thing there.”
Kawasaki disease symptoms include conjunctivitis, a fever that lasts at least five days, a very specific rash and a strawberry tongue, according to Owensby. Not all of the New Jersey patients had the full range of symptoms. And the syndrome is usually found in patients 5 years old and younger.
“These patients are coming in an older age range and not with all of the symptoms of Kawasaki, even though the rest of their symptoms look like Kawasaki,” Owensby said. “It’s not your textbook definition, but it’s very close. We’re treating them for Kawasaki.”
The question remains: What role is the coronavirus playing in this inflammation disease?
“We’re not 100% sure why or what that connection is, but it could be a stimulus for the Kawasaki-like syndrome,” Owensby said.
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Patrick Lanni may be reached at [email protected].
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