Kawasaki disease following COVID-19 infection in a 5-year-old girl

ABSTRACT

Introduction: Kawasaki disease (KD), an acute syndromic systemic vasculitis of unknown cause, usually followsa viral infection. However, the link between KD and COVID-19 is not well established. Here, we report a 5-year-old girl who developed KD during convalescent phase of COVID-19 infection. Case Description A 5-year-old girlwith no past medical history presented with a 10-day-history fever (Tmx 104.3F) associated with abdominalpain, dry cracked lips, conjunctivitis, generalize erythematous macular rash involving palms and soles, andswelling of hands and feet. On admission, patient's vital signs were stable except for fever (T 102). She fulfilledthe diagnostic criteria for KD. Her laboratory screen showed WBC, 5,000/ul;platelet, 483,000/ul;ESR, 81 mm/h;CRP;22 mg/dl;Sars-Cov-2 RNA (RT-PCR) negative. Echocardiogram revealed left coronary artery ectasia.Patient received a single dose of intravenous immunoglobulin (IVIG) and aspirin with a good response. Despitenegative history of sick contact, COVID-19 serology test was performed which showed a positive IgG and anegative IgM titer, suggestive of convalescent phase of the viral infection. Discussion: Recent data showed thatmany children with KD were tested negative for COVID-19, suggesting no increased incidence or susceptibilityto COVID-19 infection for patient with KD. With increasing utilization of COVID-19 serology testing, evidence of association between the virus and KD may start emerging. Both COVID-19 infection and KD can exhibithyperinflammatory state involving multi-systems. Our patient's positive serology, fever and gastrointestinalsymptoms indicated that her development of KD was preceded with COVID-19 infection, portending apotential role of systemic immune response triggered by the virus in KD pathogenesis. Conclusion: Cliniciansshould be vigilant for this possible new association between COVID-19 and KD. Clinical criteria for testing forCOVID-19 must not be restricted to those with respiratory symptoms. We recommend both RT-PCR based andserology test for the virus be utilized in patient with KD.