New syndrome found in kids.
NEW YORK — When a sprinkling of a reddish rash appeared on Jack McMorrow’s hands in mid-April, his father figured that the 14-yearold was overusing hand sanitizer — not a bad thing during a pandemic.
When Jack’s parents noticed that his eyes looked glossy, they attributed it to late nights of video games and TV.
When he developed a stomachache and did not want dinner, “they thought it was because I ate too many cookies or whatever,” said Jack, a ninth-grader in the Queens borough of New York who loves Marvel Comics and has ambitions to teach himself “Stairway to
Heaven” on the guitar.
But over the next 10 days, Jack felt increasingly unwell. His parents consulted his pediatricians in video appointments and took him to a weekend urgent care clinic. Then, one morning, he awoke unable to move.
He had a tennis-ball-size lymph node, raging fever, racing heartbeat and dangerously low blood pressure. Pain deluged his body in “a throbbing, stinging rush,” he said.
“You could feel it going through your veins, and it was almost like someone injected you with straight-up fire,” he said.
Jack, who was previously healthy, was hospitalized with heart failure that day, in a stark example of the newly discovered severe inflammatory syndrome linked to the coronavirus that has been identified in about 200 children in the United States and Europe and killed several.
The condition, which the Centers for Disease Control and Prevention is calling Multisystem Inflammatory Syndrome in Children, has shaken widespread confidence that children were largely spared from the pandemic. Instead of targeting lungs as the primary coronavirus infection does, it causes inflammation throughout the body and can cripple the heart. It has been compared to a rare childhood inflammatory illness called Kawasaki disease, but
doctors have learned that the new syndrome affects the heart differently and erupts mostly in school-age children, rather than infants and toddlers. The syndrome often appears weeks after infection in children
who did not experience first-phase coronavirus symptoms.
Jack’s recovery and the experience of other survivors are Rosetta stones for doctors, health officials and parents anxious to understand the mysterious condition.
“He could have definitely died,” said Dr. Gheorghe Ganea,
who, along with his wife, Dr. Camelia Ganea, has been Jack’s primary doctor for years. “When there’s cardiovascular failure, other things can follow. Other organs can fail one after another, and survival becomes very difficult.”
New York state has reported three deaths. As of Sunday, 137 cases were being
investigated in New York City alone. This month, a CDC alert urged doctors nationwide to report suspected cases.
“Everyone is doing everything they can to help look into this from all different angles just to get the answers that parents want, that we want,” said Dr. Thomas Connors, a pediatric critical care physician who treated Jack at NewYork-Presbyterian Morgan Stanley Children’s Hospital.
The week after his hand rash and stomachache, about a month after he had last set foot in school, Jack developed a 102-degree fever and sore throat. Worried, his mother arranged a video visit with the pediatricians, who started him on an antibiotic for possible bacterial infection. For several days, he felt about the same, but then other symptoms rapidly emerged: swollen neck, nausea, dry cough, a metallic taste.
On April 25, his fever spiked to 104.7, his chest felt tight and when he took deep breaths, “it hurt down in the bottom,” he said.
That morning, Camelia Ganea videoconferenced with the family while still in her pajamas, discovering that Jack could barely open his mouth. She prescribed steroids and suggested they visit an urgent care clinic. There, Jack was tested for the coronavirus, but it would be two days before results arrived.
Two days later, pain was “flowing through me like lightning,” Jack said, and a rosy rash covered his feet.
With a home monitor, his parents discovered that his blood pressure was very low. John McMorrow, his father, lifted him, placing Jack’s feet on top of his own, and shuffled him to the car. At NewYork-Presbyterian/ Weill Cornell hospital, doctors gave Jack intravenous fluids and tried to diagnose his condition. He did not have the obvious respiratory distress of COVID-19. And then they got the results of his coronavirus test: negative.
Suspecting that he might have a condition like mononucleosis, they prepared to discharge him, thinking that he could be safely watched at home with instructions to return if his blood pressure dropped again, his parents said.
His mother was urging them to keep Jack longer when his eyes turned red with a “raging case of pinkeye” and rolled back in his head, she said. After a conversation with Jack’s pediatrician, the hospital conducted its own coronavirus test. It was positive.
The doctor decided that Jack should be transferred to NewYork-Presbyterian’s pediatric affiliate, Morgan Stanley Children’s Hospital, which is treating many coronavirus cases.
His resting heart rate was 165 beats per minute, about twice as high as normal, as his heart struggled to compensate for his alarmingly low blood pressure, which was hampering its ability to circulate blood and supply his vital organs with oxygen and nutrients.
This condition is a form of heart failure called cardiogenic shock, and Jack’s was “pretty severe,” said Dr. Steven Kernie, chief of pediatric critical care medicine at the hospital and Columbia University. “Overall, his heart wasn’t working very well,” he said. “It wasn’t pumping as strongly as normal.”
Doctors could not explain why Jack’s heart function had suddenly become impaired. Its structure and rhythm were normal. But blood vessels throughout his body were inflamed, a condition called vasculitis, so the vessels’ muscles were “not controlling blood flow as well as they should,” Kernie said.
By April 29, Jack’s third day in ICU, the blood pressure medication was not helping enough and doctors began planning to insert a central line through his groin to deliver additional medications. They also prepared to put Jack, who was receiving nasal oxygen, on a ventilator, something doctors deem necessary when “your heart’s not doing its job,” said Connors of Morgan Stanley Children’s Hospital. “We didn’t know which way this was going.”
But then doctors began giving Jack steroids, which can have anti-inflammatory and immunosuppressant effects. At last, something seemed to work. Within hours, Jack needed less blood pressure medication. As the family’s pediatrician, who has training in infectious diseases and spoke to the hospital team, put it: “Jack turned into a normal Jack.”
Doctors are not sure the steroids made the difference, but since then, they have administered them much earlier to children with the syndrome, with encouraging results, Kernie said.
On May 7, 10 days after being hospitalized, Jack went home.
He will require follow-up cardiology appointments and will take steroids and blood thinners for a while. He may have some heartvalve tears and residual cardiac inflammation, but doctors expect those to heal on their own. Jack and his family have taken genetic tests as part of research into the syndrome, and he and other survivors will be followed as doctors strive to learn how to recognize and treat it.
Pausing near a model of Darth Vader’s castle on his desk, Jack said he once considered becoming an actor. He was even an extra on the TV show “Gotham,” playing a kidnapped orphan. But before getting sick, he was thinking about studying medicine. “I was really into the heart,” he said. Now, he is even more interested.