Abstract
Children with coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), usually present with symptoms of mild upper respiratory tract infection without developing any significant complications. However, this observation has been rendered incautious by hundreds of clinical cases from around the world that have depicted a less benign multisystem inflammatory illness mimicking Kawasaki disease in COVID-positive pediatric patients. Our study aimed at retrospectively reviewing the different features of Kawasaki disease-like illness in children suffering from COVID-19, including the complications, laboratory investigations, treatment strategies used during their hospital stay, and outcomes. We searched the electronic database of the two pediatric units of Mayo Hospital, Lahore, Pakistan, for children who had been admitted to the ward between April 2020 and July 2020 and were diagnosed with COVID-19. A total of 10 such pediatric cases were found, whose clinical details were then reviewed and the obtained data were presented in the form of tables and percentages. The median age was between 4 months to 11 years (mean: 6 years). Of the 10 patients, 8 (80%) were boys. Criteria for Kawasaki disease were met in all of them (100%), with a complete presentation in five (50%). Fever (100%), conjunctival and oral cavity changes (90%), and rash (80%) were the most common features. Seven (70%) patients required admission to a critical care unit, but no mortality occurred. This article can assist in understanding and dealing with Kawasaki disease-like manifestation of pediatric COVID-19 infection, especially in critical care settings, and its possible complications. It will help in a timely and appropriate decision-making regarding treatment and management of such cases.
Highlights
In 1967, Tomisaku Kawasaki described Kawasaki disease (KD) as a rare systemic vasculitis occurring in children ≥5 years of age
Children with coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), usually present with symptoms of mild upper respiratory tract infection without developing any significant complications
Our study aimed at retrospectively reviewing the different features of Kawasaki disease-like illness in children suffering from COVID-19, including the complications, laboratory investigations, treatment strategies used during their hospital stay, and outcomes
Summary
In 1967, Tomisaku Kawasaki described Kawasaki disease (KD) as a rare systemic vasculitis occurring in children ≥5 years of age. Children with symptomatic COVID-19 may develop fever, fatigue, cough, sore throat, rhinorrhea, congestion, and shortness of breath, and the critical cases present with gastrointestinal distress, shock, and respiratory failure, deranged coagulation, and renal shutdown [4]. There has been an increase in the incidence of KD-like illness among COVID-positive children, either concomitant with or after the resolution of COVID-19 infection [5]. Some cases develop a shock-like systemic inflammatory illness resembling toxic shock syndrome, which is identified as a multisystem inflammatory syndrome, warranting their admission to the critical care unit [6]
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