Kawasaki Disease-Like Features in 10 Pediatric COVID-19 Cases: A Retrospective Study

Abstract

Children with coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), usually present with symptoms of mild upper respiratory tract infection without developing any significant complications. However, this observation has been rendered incautious by hundreds of clinical cases from around the world that have depicted a less benign multisystem inflammatory illness mimicking Kawasaki disease in COVID-positive pediatric patients. Our study aimed at retrospectively reviewing the different features of Kawasaki disease-like illness in children suffering from COVID-19, including the complications, laboratory investigations, treatment strategies used during their hospital stay, and outcomes. We searched the electronic database of the two pediatric units of Mayo Hospital, Lahore, Pakistan, for children who had been admitted to the ward between April 2020 and July 2020 and were diagnosed with COVID-19. A total of 10 such pediatric cases were found, whose clinical details were then reviewed and the obtained data were presented in the form of tables and percentages. The median age was between 4 months to 11 years (mean: 6 years). Of the 10 patients, 8 (80%) were boys. Criteria for Kawasaki disease were met in all of them (100%), with a complete presentation in five (50%). Fever (100%), conjunctival and oral cavity changes (90%), and rash (80%) were the most common features. Seven (70%) patients required admission to a critical care unit, but no mortality occurred. This article can assist in understanding and dealing with Kawasaki disease-like manifestation of pediatric COVID-19 infection, especially in critical care settings, and its possible complications. It will help in a timely and appropriate decision-making regarding treatment and management of such cases.

Severe SARS-CoV-2 Infection: A Multisystem Inflammatory Syndrome in Moroccan Children

“…An observational study from the Bergamo province in Italy, which had a high rate of SARS-CoV-2 infections at that time, reported a 30-fold increased monthly incidence of KD in a cohort of children from February 18, 2020, to April 20, 2020, compared with a cohort of patients from the previous five years [ 14 ]. The same hyperinflammatory shock in children has also been observed in France, Spain, Portugal, and Pakistan [ 10 , 15 ]. Interestingly, some series noted frequent gastrointestinal symptoms, including bloodless diarrhea, abdominal pain, severe vomiting, and imaging revealed ascites and ileitis [ 7 , 14 ].…”

SARS-CoV-2–related MIS-C: A key to the viral and genetic causes of Kawasaki disease?

“…There has been a striking paucity of MIS-C cases from East Asia, despite the high incidence of KD in this geographic area ( Kim et al, 2020b ; Li et al, 2019 ). Only two cases of MIS-C have been reported to date in South Korea, and no cases have been reported in Japan or China ( Toyo Keizai Online COVID-19 Task Team, 2021 ), contrasting with the higher numbers of cases from the Americas, Europe, Africa, South Asia, and the Middle East ( Almoosa et al, 2020 ; Dufort et al, 2020 ; Falah et al, 2020 ; Feldstein et al, 2020 ; Jain et al, 2020 ; Kim et al, 2020a ; Kim et al, 2020b ; Lee et al, 2021 ; Mamishi et al, 2020 ; Ulloa-Gutierrez et al, 2020 ; Verdoni et al, 2020 ; Webb et al, 2020 ). Whether this is merely due to a lower number of COVID-19 cases in East Asia remains to be seen, bearing in mind the possibility of ascertainment bias ( Fig.…”

Oral mucosal lesions in patients with COVID-19: a systematic review

“…One study only reported recurrent aphthous stomatitis in COVID-19 patients, and one study reported oral changes but failed to describe the type of changes noted. 10 , 11 …”