Understanding Coronavirus associated PMIS which mimics Kawasaki Disease

PMIS patients tend to be older than typical Kawasaki Disease patients, and some of their blood test including markers of inflammation are more abnormal than patients with Kawasaki Disease, says Dr Kumar P Salvi

Kawasaki Disease, Paediatric Multisystem Inflammatory Syndrome, Paediatric Care, Dr Kumar P Salvi, Kawasaki Disease Shock Syndrome, Inflammation, Corona Virus


Over time, a number of COVID positive critically ill children started presenting to hospitals across the country, much like in the United States & United Kingdom. In this cluster of sick children, what is being called ‘Paediatric Multisystem Inflammatory Syndrome’ or PMIS was observed. Some of these cases were similar to a rare inflammatory illness called Kawasaki Disease, which baffled the caregivers.  

Kawasaki Disease is a rare inflammatory disease that causes blood vessels to become inflamed. More than 80% of children who get it are younger than five years of age. The hallmark of Kawasaki Disease is as follows -  persistent high-grade fever for at least four days, rash, redness of eyes, lips & tongue, swelling and redness of hands & feet, and Cervical Lymph Adenopathy. Kawasaki Disease Shock Syndrome is a rare form of this disease, and is characterized by severe inflammation resulting in the child becoming critically ill.

What is pediatric multisystem inflammatory syndrome (PMIS) and its relation to Coronavirus infection? Coronavirus infection generally presents in children with very mild symptoms such as fever, cough and runny nose, but in small number of children, the presentation showed critical symptoms resembling Kawasaki Disease and Kawasaki Disease Shock Syndrome.

Similar cases of critically ill children with Coronavirus infection has been reported across Europe and United States. Some PMIS patients were found to carry the virus causing COVID-19, and some had proteins in their body showing that they previously had the infection. A significant number of patients were exposed to someone with COVID-19 infection.

Key finding of PMIS is evidence of severe inflammation, which is similar to Kawasaki Disease and like Kawasaki Disease, children with PMIS also have high fever and can present with red eyes, and rash. However, PMIS patients tend to be older than typical Kawasaki Disease patients, and some of their blood test including markers of inflammation are more abnormal than patients with Kawasaki Disease. Severe abdominal pain and diarrhea is another common complaint with PMIS.

So far, we know the similarities between these two diseases, but we do not have sufficient information to fully understand the differences. At this time, we do recommend seeking medical evaluation If your child has persistent fever over 101 degrees Fahrenheit, as well as severe abdominal pain, Diarrhea, and rash that could not be explained by another cause.

Dr Kumar P Salv is, HOD-Pediatrics with Hiranandani Hospital, Vashi-A Fortis Network Hospital.