Children with Kawasaki disease or Kawasaki-like syndrome (MIS-C/PIMS) at the time of COVID-19: are they all the same? Case series and literature review

• Main Authors: A. Marino, T. Varisco, G. Quattrocchi, A. Amoroso, D. Beltrami, S. Venturiello, A. Ripamonti, A. Villa, M. Andreotti, M. Ciuffreda, R. Cimaz
• Format: Article
• Language: English
• Published: PAGEPress Publications 2021-04-01
• Series: Reumatismo
• Subjects: Kawasaki disease; COVID-19; SARS-COV-2; myocarditis; PIMS-TS; Macrophage Activation Syndrome (MAS)
• Online Access: https://www.reumatismo.org/index.php/reuma/article/view/1331
• ISSN: 0048-7449; 2240-2683

Since the coronavirus disease 2019 (COVID-19) outbreak started, children have been considered marginally involved compared to adults, with a quite significant percentage of asymptomatic carriers. Very recently, an overwhelming inflammatory activation, which shares clinical similarities with Kawasaki disease (KD), has been described in children exposed to COVID-19. We report three KD-like cases that occurred during the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a highly affected area of Northern Italy. The clinical presentation was characterized by the presence of unremitting fever, diarrhea and elevated inflammatory markers. Case #1 and Case #2 occurred one week apart and shared other clinical features: laboratory tests confirmed COVID-19 exposure and high inflammatory activation with myocardial involvement. Case #3 followed a more typical pattern for KD. Interestingly, this patient showed lower levels of procalcitonin, C-reactive protein, D-dimers, and ferritin compared to the other two cases, whereas platelet count was higher. We hypothesize that SARS-CoV-2 might act in children as a trigger, either inducing a classical KD phenotype or causing a systemic inflammatory response leading to a severe KD-like phenotype, eventually characterized by myocardial impairment. We think that bringing these cases and their differences to the attention of the rheumatology community during the COVID-19 pandemic will be beneficial in order to highlight the importance of early diagnosis and to increase awareness of this new phenomenon.