As the coronavirus pandemic spread across New Jersey in mid-March, a young patient arrived in a Bergen County emergency room with a different set of concerns.
Septic shock. Low blood pressure. Signs of cardiac failure.
A coronavirus test came back negative.
But more than six weeks later, doctors at Hackensack University Medical Center say this case, originally diagnosed as pneumonia, was possibly the first patient with a rare inflammatory illness in children being linked to the coronavirus.
“In this case, there were a ton of things that weren’t on our radar screen at the time relating to COVID,” Dr. Aryeh Baer, an infectious disease specialist at Hackensack University Medical Center, told NJ Advance Media on Thursday. “When he tested negative, we didn’t think much of it from a COVID point of view.
“Looking back on that now, we were wrong about passing it off because there was a link after all.”
Doctors and health officials have identified at least 12 children — five at Hackensack, five at Rutgers Robert Wood Johnson University Hospital in New Brunswick and two at St. Joseph’s Hospital in Paterson — who have been or are being treated for a syndrome that resembles Kawasaki disease, an illness that causes inflammation in blood vessels.
The majority of the patients, who range between the ages of 3 and 13, have recovered and none have died. All five who were treated at Hackensack have been discharged. Three of the five at Rutgers RWJ remain in intensive care and one of the two at St. Joseph’s remains hospitalized.
“It’s really not a common thing yet and hopefully won’t be,” Baer said. “We’ll see what happens. What’s important is that parents keep an eye out. They need to keep an eye out that their child may be sicker from this than a typical viral illness.”
The New Jersey Department of Health first acknowledged cases on Wednesday. More than 60 patients have been diagnosed in New York state, after European health officials warned doctors to look out for it.
During Gov. Phil Murphy’s media briefing on Thursday, Dr. Edward Lifshitz urged hospitals and health care workers to be aware of Kawasaki-like cases relating to the coronavirus. However, the state Department of Health’s medical director stressed the disease is rare.
“This is not something that I’m terribly concerned about,” Lifshitz said. “We do not know exactly how often it occurs, but certainly it’s rare. So certainly this isn’t something that’s going to have a large impact on the kids that are out there, but we do want clinicians to be aware because it’s certainly something that can happen or appears possible to be something that needs to be reacted on quickly if it does happen.”
In New Jersey, there have been no coronavirus deaths in people younger than 18. Only 2% of the state’s 133,635 positive tests have been pediatric cases, Lifshitz said.
The patients at Rutgers RWJ had carditis — inflammation of the heart — and cardiomyopathy, a disease of the heart muscle that hinders its ability to pump blood. Cardiac failure makes the illness potentially deadly if untreated, according to Dr. Jennifer Owensby, medical director of the pediatric intensive care unit at Rutgers RWJ.
Kawasaki disease symptoms include conjunctivitis, a fever that lasts at least five days, a very specific rash and a strawberry tongue, according to Owensby. Her patients in New Brunswick have showed several symptoms, but not all that are required to be diagnosed with Kawasaki, a disease usually found in kids younger than 5.
She suspects the coronavirus is causing a post-infection syndrome that is quite similar to Kawasaki disease. The first case in her unit arrived at the end of April. All five cases tested positive for the coronavirus.
“What happens is they get COVID. They may or not have symptoms, but this develops later with the inflammation of the immune system,” Owensby said. “It usually is seen later after an infection, so I think that’s why we’re seeing it later.”
However, not all of the patients at Hackensack University Medical Center tested positive for the coronavirus.
It’s unclear how the inflammatory disease relates to the virus. Lifshitz said the health department is seeking guidance from the Centers for Disease Control and Prevention and gathering more information from health commissioners to get a better understanding.
Baer said while not all five patients who were treated at Hackensack tested positive for the coronavirus, the inflammatory syndrome was likely a “post-infectious manifestation” that could have developed even if the patients were asymptomatic.
The virus may not have severely impacted the children, “but it’s an immune response that causes collateral damage to different systems of the body and the sepsis syndrome we’re seeing,” Baer said.
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