https://doi.org/10.4081/reumatismo.2021.1331
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
Submitted: 3 August 2020
Accepted: 18 December 2020
Published: 19 April 2021
Accepted: 18 December 2020
Abstract Views: 6870
PDF: 1403
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
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.
Sethuraman U, Kannikeswaran N, Ang J, et al. Multisystem inflammatory syndrome in children associated with novel coronavirus SARS-CoV-2: Presentations to a pediatric emergency department in Michigan. Am J Emerg Med. 2020; S0735-6757(20)30931-1.
Verdoni L, Mazza A, Gervasoni A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020; 395: 1771-8
DOI: https://doi.org/10.1016/S0140-6736(20)31103-X
Riphagen S, Gomez X, Gonzalez-Martinez C, et al. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020; 395: 1607-8.
DOI: https://doi.org/10.1016/S0140-6736(20)31094-1
Mamishi S, Movahedi Z, Mohammadi M, et al. Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran. Epidemiol Infect. 2020; 148: e196.
DOI: https://doi.org/10.1017/S095026882000196X
Royal College of Paediatrics and Child Health (2020) Guidance - Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. Available from: https://www.rcpch.ac.uk/resources/guidance-paediatric-multisystem-inflammatory-syndrome-temporally-associated-COVID-19. Accessed: 5 May 2020.
WHO. Multisystem inflammatory syndrome in children and adolescents with COVID-19; 2020. Available from: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-COVID-19 Accessed: 15 May 2020.
CDC. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19); 2020. Available from: https://emergency.cdc.gov/han/2020/han00432.asp Accessed: 14 May 2020.
Belhadjer Z, Méot M, Bajolle F, et al. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic. Circulation. 2020; 142: 429-36.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.048360
Toubiana J, Poirault C, Corsia A, et al. Kawasaki-like multisystem inflammatory syndrome in children during the COVID-19 pandemic in Paris, France: prospective observational study. BMJ 2020; 369: m2094.
DOI: https://doi.org/10.1136/bmj.m2094
Pouletty M, Borocco C, Ouldali N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis. 2020 ;79: 999-1006.
DOI: https://doi.org/10.1136/annrheumdis-2020-217960
Whittaker E, Bamford A, Kenny J, et al; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA. 2020; 324: 259-69.
DOI: https://doi.org/10.1001/jama.2020.10369
Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020; 383: 334-46.
DOI: https://doi.org/10.1056/NEJMoa2021680
Dufort EM, Koumans EH, Chow EJ, et al; New York State and Centers for Disease Control and Prevention Multisystem Inflammatory Syndrome in Children Investigation Team. Multisystem inflammatory syndrome in children in New York State. N Engl J Med. 2020; 383: 347-58.
DOI: https://doi.org/10.1056/NEJMoa2021756
Ramcharan T, Nolan O, Lai CY, et al. Paediatric inflammatory multisystem syndrome: temporally associated with SARS-CoV-2 (PIMS-TS): cardiac features, management and short-term outcomes at a UK Tertiary Paediatric Hospital. Pediatr Cardiol. 2020; 41: 1391-401.
DOI: https://doi.org/10.1007/s00246-020-02391-2
Cavalli G, De Luca G, Campochiaro C, et al. Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study. Lancet Rheumatol. 2020; 2:e325-31.
DOI: https://doi.org/10.1016/S2665-9913(20)30127-2
How to Cite
Marino, A., Varisco, T., Quattrocchi, G., Amoroso, A., Beltrami, D., Venturiello, S., … Cimaz, R. (2021). 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. Reumatismo, 73(1), 48–53. https://doi.org/10.4081/reumatismo.2021.1331
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
Similar Articles
- C. Rothschild, B. Rothschild, I. Hershkovitz, Clues to recognition of kidney disease in archeologic record: characteristics and occurrence of leontiasis ossea , Reumatismo: Vol. 54 No. 2 (2002)
- E. Taccari, A. Spadaro, M.L. Sorgi, V. Riccieri, B. Mora, Role for familiarity and genetic features in the therapeutic response of psoriatic arthritis , Reumatismo: Vol. 56 No. 3 (2004)
- L. Quartuccio, M. Fabris, G. Ferraccioli, B Lymphocyte stimulator (BLyS) and monocytes: possible role in autoimmune diseases with a particular reference to rheumatoid arthritis , Reumatismo: Vol. 56 No. 3 (2004)
- M. Frassi, A. Brucato, I. Cavazzana, F. Franceschini, D. Faden, M. Motta, A. Doria, R. Cimaz, M.P. Pisoni, M. Muscarà, G. Castellino, G. Brambilla, P.L. Meroni, R. Cattaneo, C. Biasini Rebaioli, C. Antonioli, G. Balestrieri, A. Tincani, Neonatal lupus: clinical features and risk of congenital cardiac heart block in newborns from mothers with anti Ro/SSA antibodies , Reumatismo: Vol. 53 No. 4 (2001)
- C. Pizzorni, M.E. Secchi, M. Cutolo, Leishmaniasis in rheumatoid arthritis , Reumatismo: Vol. 59 No. 3 (2007)
- A.S. Hammami, M. Jellazi, S. Arfa, S. Daada, K. Ben Hamda , A. Achour, S. Ouali, Getting to the heart of the matter: diagnostic tools and therapeutic approach to cardiac involvement in Behçet syndrome A Tunisian case series , Reumatismo: Vol. 73 No. 1 (2021)
- A. Fassio, D. Gatti, P. Gisondi, G. Girolomoni, O. Viapiana, A. Giollo, M. Zamboni, M. Rossini, L. Idolazzi, Effects of secukinumab on serum adipocytokines: preliminary data , Reumatismo: Vol. 69 No. 3 (2017)
- M. Mosca, C. Tani, C. Neri, A. Della Rossa, C. Baldini, R. Talarico, L. Carli, S. Bombardieri, Analysis of the evolution to defined connective tissue diseases of patients with “early unidifferentiated connective tissue diseases (UCTD)” , Reumatismo: Vol. 60 No. 1 (2008)
- B. Gharib, A. Ghareh Zadeh Shirazi, E. Moradi, B. Yaghmaei, V. Ziaee, A rare disease with a rare presentation: hemi-atrophy caused by fibromuscular dysplasia in a 27 month old girl , Reumatismo: Vol. 71 No. 1 (2019)
- Irene Pontikaki, Valeria Gerloni, Maurizio Gattinara, Alfredomaria Lurati, Alessandra Salmaso, Gabriele De Marco, Barbara Teruzzi, Elisabetta Valcamonica, Flavio Fantini, Side effects of anti-TNFa therapy in juvenile idiopathic arthritis , Reumatismo: Vol. 58 No. 1 (2006)
<< < 15 16 17 18 19 20 21 22 23 24 > >>
You may also start an advanced similarity search for this article.
