Multi-System Inflammatory Syndrome in a Child Mimicking Kawasaki Disease

Abstract

There have been recent reports of children presenting with severe multi-system hyperinflammatory syndrome resembling Kawasaki disease (KD) during current COVID-19 pandemic. Exact pathophysiology is unknown, however, most of the children have multi-organ dysfunction and respiratory system involvement is less common compared to adults. These patients have certain characteristic laboratory parameters different from those seen in children with KD. However, only limited literature is available at present for identification and management of such patients. We report a young girl who presented with fever, rash and other manifestations mimicking classic KD and fulfilling the case definitions for pediatric multi-system inflammatory syndrome. She had lymphopenia, thrombocytopenia and hyponatremia in the absence of macrophage activation syndrome, similar to that seen in patients reported from UK and Italy. Clinical manifestations resolved and laboratory parameters improved with intravenous immunoglobulin and corticosteroids. Early recognition is important to administer immunomodulatory therapy which may be life saving for these patients.

Multisystem inflammatory syndrome in an adult following the SARS-CoV-2 vaccine (MIS-V)

“…However, we suspect similar pathophysiology seen in MIS-C and MIS-A may play a key role in patients with MIS-V, causing immune system dysregulation and cytokine storm, leading to multiorgan dysfunction. 26 As demonstrated in managing this patient, a diagnosis of MIS-V is a decision of exclusion that requires a high index of clinical suspicion. Hyperinflammatory syndromes such as acute COVID-19, macrophage activation syndrome and sepsis must be ruled out before considering MIS-V in patients who receive SARS-CoV-2 vaccinations.…”

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

“… N.A. [ 213 ] 1 (non-confirmed) F 7 PIMS-TS IVIg, glucocorticoids, ASA Recovered [ 214 ] 3 (2 confirmed) 2 M 1 F 6y PIMS-TS 2 shock IVIg, ASA Recovered [ 215 ] 570 (565 confirmed) 316 M 254 F 8y MIS-C 202 shock 424 IVIg, 331 glucocorticoids, 309 ASA 10 Deaths 95 Coronary artery abnormalities [ 216 ] 30 (2 confirmed) 12 M 2 F 2y 22 complete KD, 8 atypical KD 30 IVIg, 14 IVIg + glucocorticoids, Recovered 2 Coronary artery aneurysms [ 217 ] 25 (17 confirmed) 15 M 10 F 12.5y MIS-C 23 IVIg, 20 glucocorticoids, 10 TCZ, 4 infliximab, 1 anakinra Recovered 7 Coronary artery abnormalities [ 218 ] 11 (all confirmed) 9 M 2 F 59m PIMS-TS, 5 shock N.A. 2 Deaths [ 219 ] 1 (confirmed) M 45y KD IVIg, TCZ, topical glucocorticoids Recovered [ …”

Skin Manifestations Associated with COVID-19: Current Knowledge and Future Perspectives

“…Other peculiar rare COVID-19-related cutaneous manifestations that cannot be pigeonholed in the classification proposed by our group [2] include, among others, the erythema multiforme-like eruption [83], pityriasis rosea-like rash [84], multi-system inflammatory syndrome in children [85], anagen effluvium [86] and a pseudoherpetic variant of Grover disease [87]. However, the spectrum of possible COVID-19-associated skin manifestations is likely to be still incomplete, and it is expected that new entities associated with this infection will be described.…”