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PAEDIATRIC INFLAMMATORY SYNDROME TEMPORALLY ASSOCIATED
WITH SARS-CoV-2 (PIMS-TS)

You may have seen the recent media reports regarding the Kawasaki disease-like hyperinflammatory syndrome that has rarely been reported following COVID-19. We provide some brief background information and links to more detailed resources.

This newly described condition is called Paediatric Inflammatory Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) and is known as Multisystem Inflammatory Syndrome in Children (MIS-C) in the US. It was first recognised in Europe and the US in April 2020. Even in places with very high infection rates of SARS-CoV-2 (the virus that causes COVID-19), PIMS-TS remains rare. A very small number of cases have been reported in Australia and not all cases have been confirmed. PIMS-TS is therefore a rare condition (much rarer than Kawasaki disease, KD) and it is unlikely that we will see more than a handful of cases in Australia if COVID-19 rates remain relatively low.

An alert regarding PIMS-TS was issued to paediatricians in Victoria recently by Safer Care Victoria. This was to raise awareness so that paediatricians considered the possibility of this rare diagnosis in children with suggestive features.

PIMS-TS typically occurs about 4 weeks after infection with SARS-CoV-2, so it is a post-infectious illness, rather than directly due to the SARS-CoV-2 virus itself. This means that PIMS-TS likely results from the immune response to the virus. COVID-19 is often mild or asymptomatic in children, so it may not have been obvious that children were infected in the first place. The peak age for PIMS-TS is about 9 years, younger is typical for KD, which peaks between 1 and 2 years.

The features of PIMS-TS may include abdominal pain, fever, rash and red eyes. It may cause inflammation of the heart and dilatation of the coronary arteries (like in KD). The cardiovascular and other features of PIMS-TS usually resolve promptly with treatment, which includes intravenous immunoglobulin (IVIG) and sometimes steroids.

Although PIMS-TS shares some features of KD, they appear to be distinct illnesses. There is also no indication that it is more common in children who have previously had KD. Interestingly, there are no reports of PIMS-TS cases from North East Asia, where KD is much more common than elsewhere.

FOR FURTHER INFORMATION REGARDING PIMS-TS AND COVID-19 IN CHILDREN:
MCRI Podcast series: https://www.mcri.edu.au/podcasts/coronavirus-parenting
News GP article: https://www1.racgp.org.au/newsgp/clinical/further-cases-of-pims-ts-likely-in-australia

DISCLAIMER: This information is for general information only and should not be taken as individual medical advice. If your child is unwell, please consult a medical practitioner.

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