Doctors’ Notes


Kawasaki Disease, MIS-C, and “COVID-Toes”

UPDATED: 5.15.20

By now you’ve probably seen news reports with headlines like, Children hospitalized with mysterious syndrome possibly linked to COVID-19.

These are headlines designed to grab your attention, and — especially if you’re a parent — that’s exactly what they do. As always, we’re here to tell you what you need to know to sort through all of the scary click-bait headlines…

Because COVID-19 is a world-wide situation, doctors and scientists from all over the world are communicating with each other to share what they’ve observed & learned. One thing that has been seen everywhere is that children are far less affected than adults, with both a much lower frequency and a much lower severity of illness.

As we have more experience with this virus, we continue to hear new reports about small numbers of children with unusual symptoms that MAY turn out to be manifestations of infection by SARS-CoV-2, the new coronavirus.

Last week the news was about clusters of an illness called Kawasaki Disease.

Kawasaki Disease is not common, but it’s also not rare, and we’ve known about it for decades. It’s one of those illnesses that every doctor who takes care of kids knows about and has seen, but few parents or non-medical folks have heard of. It’s most common in young children, but can happen in older children as well. We still don’t completely understand what causes KD, but it’s believed to be the result of something infectious (like a virus) triggering the body’s immune system to cause inflammation. Scientists wondered if SARS-CoV-2 cold be causing more cases of KD.

As doctors around the world continue to compare notes, it’s now becoming clear that the illness is not exactly the same as Kawasaki Disease, but is very similar. It seems to be a slightly different illness, likely caused by the new coronavirus. The new illness has a lot of features similar to Kawasaki Disease, and a few that are different.  It’s been given a new name: Multisystem Inflammatory Syndrome in Children (MIS-C).

There are a couple of important things that important for you to know.

First: This is still a VERY rare thing. Whole countries are still reporting very low-triple-digit numbers of cases.

Second: This is NOT subtle when it happens. If your child is just a little bit sick, you don’t have to worry about this. Kids with PMIS have persistent high fevers for 4 or 5 days (rather than the usual 2-3 days of fever with most viral illnesses), vomiting, diarrhea and/or abdominal pain, and a rash. They may also have a cough or trouble breathing, or seem confused or overly sleepy. If your child has these symptoms, we absolutely want you to call us — which you would, because again, they are not subtle.

As always, we’ll keep you informed with the most up-to-date information. And we’re always here to help, either with an easy phone call or an easy, safe visit to the office.


The other unusual symptom you may have seen reports on are “COVID-Toes.” These are described as red or purple blotches on the slightly swollen toes of otherwise healthy children, some of whom have then gone on to test positive for the new coronavirus. They toes look like they’ve been frostbitten, but without any history of cold exposure. Most children with this symptom have been without other symptoms, and the rash usually goes away on its own — although we still don’t really know enough to say there’s a definite pattern.

This may be another way that this virus causes inflammation in the vascular system. Most of these kids have not otherwise been sick, but as we’ve all heard, kids can be carriers of the virus and share it with higher-risk adults around them, so this toe-finding may be an important marker that a child has been infected and needs to stay home and away from others for at least 14 days.

Here too, if you have concerns about your child’s toes — or about anything else — just call us in the office.

Dr. Springer, a Shareholder in the practice, has been a Kids Plus Provider since 2003.