COVID-19 and Kawasaki Disease: Finding the Signal in the Noise.

Abstract

On April 7, 2020, Hospital Pediatrics published a case report describing an infant who was diagnosed with and treated for Kawasaki disease (KD) and also happened to test positive for severe acute respiratory syndrome coronavirus 2, the causative agent of coronavirus disease (COVID-19).1 Before this publication, we had been reading multiple reports of vascular and multisystem inflammatory involvement in adult patients with COVID-19. Although our journal does not traditionally publish case reports, we felt that this case could help spark awareness of a possible association and trigger further investigations in children. However, we were also cognizant that the COVID-19 positivity and the KD in the published case may have been “true, true and unrelated.” We also recognized (as did the article authors) that the association, if true, had few if any clinical implications for the case in question. Since then, attention over a possible association between COVID-19 and KD and other hyperinflammatory states has mounted. On April 26, an alert was sent to general practitioners in London advising them of rising numbers of cases of a multisystem inflammatory state in children with overlapping features of toxic shock syndrome (TSS) and atypical KD. These cases were subsequently described in a correspondence in the Lancet on May 7, 2020, in which researchers detailed 8 children with critical illness characterized by severe inflammation, although not all had confirmed COVID-19 infection or exposure.2 In Bergamo, Italy, KD was diagnosed in 20 children over a short period, roughly equivalent to the total number of cases that …