A Scary Diagnosis

Toddler Back to 'Sassy' Self After Dual Diagnosis by OU Medicine Pediatrician

Parents of young children know that a child’s illness can take a rapid turn, unexpectedly escalating from minor to serious. Symptoms that appear mild may worsen, possibly indicating the need for prompt, if not immediate medical attention.

When 2-year-old Kyla Voegerl of Lawton developed a persistent fever in early April, followed by loss of appetite and lethargic behavior, her mother, Alexandria Voegerl, knew it was time to act. Ultimately, a rash and swelling of the skin began to occur.

An urgent care visit was the first step toward critical care. Kyla’s symptoms seemed consistent with hand, foot and mouth disease, and treated for that diagnosis, her condition improved slightly. However, further testing confirmed Kawasaki disease, a rare condition characterized by inflammation in blood vessels throughout the body.

Kyla was taken to The Children’s Hospital at OU Medicine. As part of the protocols imposed by the pandemic, still accelerating in mid-April, the child underwent testing for COVID-19 and was found to be positive for the virus. Kawasaki disease is rare; COVID-19 is very new and somewhat mysterious. Kyla had both, and her mother was stunned and frightened. To make matters worse, Voegerl’s husband, Matt, was in isolation, having just returned from military service in Korea. It was weeks before the family could be reunited and experience the comfort of physical presence.  

Voegerl said despite all the material she had read about COVID-19, there was a great deal of confusing and sometimes contradictory information, especially related to how the virus affects children. In comments directed to other parents, Voegerl urged them not to casually dismiss symptoms.

“Make sure you are checking their temperature; keep in touch with the doctors,” Voegerl said. “I had no idea. I just thought she was sick, and it could have been a lot more serious.”

Nicholas Peterson, M.D., a pediatrician at The Children’s Hospital, said the fluid nature of the COVID-19 pandemic has posed unusual challenges, particularly in the diagnosis and treatment of children.

“Even though Kyla tested positive, she didn’t really exhibit the classic adult symptoms that you see with a COVID-19 infection," he said.

Kawasaki disease, also called mucocutaneous lymph node syndrome because of glandular swelling that occurs during infection, primarily affects children younger than 5 years of age. Symptoms advance in three phases, with persistent fever typically being the first to present.

Peterson said other families across the country have faced similar circumstances related to the pandemic, fighting a disease called MIS-C—multisystem inflammatory syndrome. Media accounts report children experiencing heart attacks and lengthy stays in intensive care units. While MIS-C is linked in some way to COVID-19, the connection is unclear and not well understood. According to Peterson, these are important distinctions even though the disease process is similar.   

Kyla responded well to treatment and was discharged after a few days. Voegerl said Kyla is once again her “sassy self,” doing well and going for periodic check-ups. Family members had to continue to self-isolate for two more weeks after Kyla’s release from the hospital. Voegerl is thankful that she and the doctors acted quickly, and that the pediatric experts at The Children’s Hospital knew what to do.

“It was the scariest thing for me because this is my baby,” said Voegerl. “[Dr. Peterson] was so kind and calm; he just talked to me and let me know all the information I needed.”

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