Kawasaki-like Disease Research Articles

A bibliometric analysis of Kawasaki disease from 1974 to 2022

ObjectiveTo analyse the research history, development trends and current status of relevant literature in the field of Kawasaki disease, and to provide the basis for future directions in Kawasaki disease (KD) research. MethodsLiterature on Kawasaki disease published between January 1974 and December 2022 was searched for in the Web of Science database, and CiteSpace was used to perform visual analyses. ResultsThe search yielded a total of 6950 articles. The number of publications related to Kawasaki disease showed an increasing trend. A collaborative network analysis revealed that the United States, Japan and mainland China were the most influential countries in this field. The University of California system contributed the most publications and the journal with the most publications was Circulation. JW Newburger was an authoritative author in this field. “Coronary artery lesion”, “Intravenous immunoglobulin” (IVIG) and “Risk factor” were three prominent keywords. Keyword bursts changed from “TNF” and “IVIG”, which focused on aetiology and treatment, to “Long term management”, which emphasized the recovery period, and to “Kawasaki-like disease” and “Multisystem inflammatory syndrome” during the novel coronavirus pandemic. Trends of highly cited references indicated that landmark articles in different periods focused on Kawasaki disease guidelines, gene polymorphisms and multisystem inflammatory syndrome caused by the novel coronavirus. ConclusionThe aetiology of Kawasaki disease remains unclear, but viral infection is likely to play an important role. The combination of evolving sequencing technologies, large-scale epidemiological investigations and prospective cohort studies is likely to be important in exploring Kawasaki disease and improving its prognosis in future.

Lipid Therapy for Dyslipidemic Disorders Activates 21st Century Nano Antioxidant Hydrogen as a Potential Anti-COVID-19 Agent: Review

According to the World Health Organization (WHO), coronavirus infection (COVID-19, (COronaVIrus Disease 2019) is an infectious disease caused by the SARS-CoV-2 virus [1]. SARS-CoV-2 virus, Severe Acute Respiratory Syndrome-related coronavirus 2. Initially considered pulmonary - respiratory pathology, then it turned out to be poly-systemic, with multi-inflammation of many other organs, and central nervous system. Multisystem inflammatory syndrome in adults (MIS-A) [2], SARS-CoV-2 liver infection [3]. In pediatrics Multisystem inflammatory syndrome in children (MIS-C) or PMIS-TS (Pediatric MIS temporarily associated with SARS-CoV-2 infection) [4,5], SARS-COV-2/ COVID-19 in children induce Kawasaki-Like Disease [6]. Neurological manifestations [7], recurrence of COVID-19 infection with meningitis without pulmonary involvement [8]. Brain damage in COVID is primarily neurological, as a material signaling pathway of inflammatory COVID-infection of cerebral vessels. This is important, from the release of these patients, from additional stress, suffering, stigmatization in society, their isolation, intimidation, coercion (bullying) with violation and restriction of their rights. Since, concomitantly with inflammatory lesions of many organs, cognitive deficits are a component of the post-acute consequences of COVID-19 (PASC), where the role of the kynurenine pathway is significant with temporary cognitive impairment [9]. The main pathway for the breakdown of tryptophan is an amino acid, without which the synthesis of serotonin is impossible, which controls the cycles of sleep and wakefulness, which is the precursor of the sleep hormone melatonin In patients with COVID-19, an imbalance of T-helpers 1 and 2 leads to a cytokine storm that can contribute to myocardial damage [10]. MIS is conditioned caused by immunocompromising (IC) CHAOS - [C]ardiovascular Compromise: shock; [H]omeostasis; [A]poptosis; [O]rgan Dysfunction; [S]uppression of the Immune System with the development of Systemic inflammatory response syndrome (SIRS) and Multiple Organ Dysfunction Syndrome (MODS) [11,12]. With pronounced multiple and other symptoms: Electro - Ion Membrane Distress Syndrome (Syndrome Maria & Irina Vasilieva) [13,14] with membrane manifestations of electrical storm or electromembrane paralysis; Capillary Leak Syndrome; Microcirculatory-Mitochondrial Distress Syndrom [15,16]. Also described: Overlap mechanisms of transient global amnesia and COVID-19 infection [17]; Hypokalemia-stroke mimic [18]; Differential diagnosis of cacosmia and dysgeusia in COVID-19 pandemic [19].

Secondary Vasculitis Attributable to Post-COVID Syndrome.

While the acute phase of the COVID-19 pandemic has largely come to pass, the chronic physiologic effects of the coronavirus continue to unfold. Specifically, the number of COVID-19-associated vasculitis cases has steadily increased since the onset of the pandemic. Data have shown that vasculitis may develop less than two weeks after COVID-19 or during a later onset of the disease. At this time, research has demonstrated that the novel coronavirus invades more than just the lungs; it can also attack the nervous system, cardiovascular system, and kidneys. In addition, there is a greater understanding of the pathogenesis regarding COVID-19-induced vasculitis via humoral immunity and immune complex disease. Recent case reports have shown an association between COVID-19 and secondary vasculitis. This review paper discusses case reports and data that suggest that COVID-19 may lead to specific vasculitis diseases such as giant cell arteritis, ophthalmic arteritis, aortitis, and Kawasaki-like disease. More research needs to be performed on this association to aid in diagnosis and treatment.

Epidemiological Profile and Management of Kawasaki Syndrome at Rabat Children’s Hospital: A retrospective study from Morocco

Kawasaki disease (KD) is a common pediatric vasculitis with a risk of coronary artery aneurysm. In this report, we review some particularities of KD disease, especially coronary involvement, and highlight its aspects during the COVID-19 epidemic which saw the emergence of a syndrome named multisystem inflammatory syndrome in children (MIS-C). Because of its many similarities with KD, MIS-C is often referred to as Kawasaki-like disease (KLD) or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS).We report on a retrospective study on the different epidemiological, clinical, and evolutionary aspects of KD and the coronary involvement resulting from this disease before and after the pandemic. The study is based on the echocardiography records of the P4 Department at Rabat Children’s Hospital, from January 2002 to December 2021. A total of 379 patients were diagnosed with KD during that period. This includes 47 cases that were reported during the first year of the COVID-19 epidemic in Morocco (March 2020). Echocardiography results for our series show that cardiac complications wererelatively more frequent among KD patients during the COVID-19 period, perhaps because they were relatively older (67 months on average) than classic KD patients (37 months on average). However, all patients had a favorable outcome after treatment with a combination of intravenous immunoglobulin (IVIG) and aspirin. The few patients who did not respond to standard treatment received corticosteroids, and no mortality occurred. We conclude that as far as cardiac complications,KD, KLD, and MIS-C are the same core disease that is triggered under different conditions for different age groups.The emergence of the Sars-Cov-2 virus changed the epidemiologic profile of KD but not its treatment. Insights from this study would help in the decision to initiate targeted immunotherapy quickly and reduce the risk factors associated with KD.

Multicolored MIS-C, a single-centre cohort study

BackgroundThe aim of this study was to investigate the clinical and laboratory parameters that can predict the severity of Multisystem Inflammatory Syndrome in Children (MIS-C) at admission.MethodsWe conducted a single-center, partly retrospective, partly prospective, observational cohort study between November 1, 2020 and December 31, 2021, which included patients aged from 1 month to 19 years, meeting the diagnostic criteria of MIS-C. We categorized the patients into three subgroups based on clinical and laboratory markers and assessed the predictive value of these factors in terms of ICU administration and cardiac abnormalities.Results53 patients were classified in the following subgroups: Kawasaki-like disease (group 1) (47.2%, n = 25), shock with or without acute cardiac dysfunction (group 2) (32%, n = 17), fever and inflammation (group 3) (20.8%, n = 11). Subgroup analysis revealed that patients with shock and KD at initial presentation had significantly more severe manifestation of MIS-C requiring intensive care unit (ICU) treatment. Of the initial laboratory values, only CRP showed a significant difference between the 3 clinical groups, being lower in group 3. 52.6% of patients were admitted to the ICU. The median length of ICU stay was 3 days (range 3–20). ICU admission was more likely in patients with shortness of breath, renal failure (AKI) and patients with significantly increased concentrations of ferritin, D-dimer, INR and significantly milder increase concentration of fibrinogen. We found that fibrinogen and ferritin levels are independent risk factors for ICU admission. Cardiac abnormalities were found in 56.6% of total (30/53), with the following findings: decreased left ventricular function (32%), coronary abnormality (11.3%), pericardial effusion (17%), arrhythmia (32.1%) and mitral regurgitation (26.6%). Diarrhea and conjunctivitis at the initial presentation with significantly elevated CRP, Pro-BNP and blood pH concentrations were found to be a potential predisposing factor for decreased cardiac function while Pro-BNP and pH were independent risk factors for MIS-C. Regardless of the initial symptoms of MIS-C, the outcome was generally favorable.ConclusionsClinical characteristics and baseline laboratory values ​​may help identify patients at increased risk for severe disease outcome, such as need for intensive care, presence of shock and decreased cardiac function.Trial registrationParticipation consent was not reqired and ethical considerations were unnecessary, since we did not perform any extra interventions, only the necessary and usual therapeutic and diagnostic methods were used.

Multisystem Inflammatory Syndrome in Children: The Importance of Early Evaluation of Laboratory Parameters

Background: Multisystem inflammatory syndrome in children (MIS-C) is an uncommon condition associated with COVID-19 with a wide spectrum of presentations, ranging from Kawasaki-like disease to multisystem involvement with shock. The association between the laboratory characteristics and unfavorable outcome has been described, but the cut-off points associated with higher risk have not yet been defined. Objective: The aim of this study was to describe and analyze the characteristics of patients with MIS-C and their associations with the laboratory findings. Methods: We conducted an analytical and retrospective study of pediatric patients hospitalized between May 2020 and June 2021 with diagnosis of MIS-C in Hospital General de Niños Dr. Ricardo Gutiérrez (HNRG). The cohort was made up of 23 patients, 17 female (53.13%) and 15 male (46.87%); mean age was 7.67 years (range 0.5-14.91). Ten patients (31.25%) presented shock. Clinical and echocardiographic data and values of high-sensitive troponin I, N-terminal pro–B-type natriuretic peptide (NT-proBNP), platelets and lymphocytes at the time of diagnosis were obtained and compared between those with shock during evolution (group 1) and those without shock (group 2). Results: There was a significant difference in baseline elevated NT-proBNP values between both groups (p = 0.008), but not in troponin levels and lymphocyte and platelet counts. Of the 13 patients who required inotropic agents, 58% had baseline lymphopenia (p = 0.006 vs those who did not require inotropic drugs). Conclusions: Although mortality due to MIS-C is low, cardiac involvement and hemodynamic impairment may be common. The availability of a commonly used laboratory tool for patient categorization could help to mitigate risks and obtain early referral to specialized centers.

Kawasaki-Like disease associated with COVID 19 in pediatrics: About a case


 
 
 Desde finales de abril de 2020, los datos sobre el síndrome Kawasaki y la respuesta hiperinflamatoria en niños asociados con COVID-19 han surgido rápidamente. Aún se desconoce mucho sobre los factores de riesgo, la patogénesis, el pronóstico y la terapia específica para esta manifestación emergente de COVID-19 conocida como Síndrome Inflamatorio Multisistémico en Niños (MIS-C). El MIS-C es raro y el reconocimiento temprano es crucial, aunque no se han establecido pautas de tratamiento estandarizadas.
 Es el primer caso de paciente que ingresa con diagnóstico de enfermedad de Kawasaki (EK) Like asociado COVID 19, en la ciudad de Tarapoto, departamento de San Martín. Es una paciente de sexo femenino de 6 años de edad, que ingresa al hospital, por presentar Fiebre persistente de 5 días, rash urticariforme, adenopatía cervical unilateral, lengua aframbuesada, labios rojo y fisurados, eritema de pulplejo de dedos de manos y pies, con prueba molecular SARS-CoV-2 POSITIVO (Ct: 32.5),con inicio de tratamiento con Inmunoglobulina 2gr/kg/d, con evolución favorable.
 
 

A global review of racial, ethnic and socio-economic disparities in multisystem inflammatory syndrome in children related to COVID-19.

With over 500 million confirmed cases and 6.2 million deaths worldwide, the novel coronavirus has highlighted the underlying disparities in healthcare, unpreparedness to deal with a new disease and the need for monitoring and surveillance for a post-infectious syndrome as well as complicated diseases. Initially, children were thought to be spared but reports of a new phenomenon manifesting as Kawasaki-like disease, toxic shock syndrome, and multi-system inflammatory syndrome, which developed after a few weeks of severe COVID-19 infection, emerged in the pediatric population. As the pandemic progressed, increased prevalence of multi-system inflammatory syndrome in children (MIS-C) related to COVID-19 was seen in non-Hispanic blacks, Asians, and Latinos as compared to the white population drawing attention to a possible role of ethnicity and socio-economic disparities. The CDC currently reports that 31% of MIS-C cases were seen in Black Non-Hispanics and 26% in Latinos, who were historically more affected in previous pandemics. Furthermore, MIS-C cases in developing countries showed higher mortality as compared to high-income countries, which points toward the role of social determinants of health and limitations in a low-resource set up in increasing the disease burden of MIS-C, which should be treated as a public health emergency. Our review highlights the role of ethnicity, socio-economic factors, comorbidities, and differences in populations affected by MIS-C in high-income vs. low- and middle-income countries.

Post-COVID Presentation of Black Hairy Tongue Treated with Topical Tretinoin

Since the COVID-19 pandemic started in 2019, the involvement of the oral mucosa is observed in many patients, tongue being the most affected area. In the recent literature, there are a wide range of lesions reported such as enanthema, Kawasaki-like disease, oral ulcers, and atrophic glossitis. This paper addresses a black hairy tongue case in a 47-year-old woman presenting after 2 weeks of COVID-19 infection. The patient was responsive to topical retinoid cream therapy.

MIS-C related to SARS-CoV-2 infection: a narrative review of presentation, differential diagnosis, and management.

Multisystem Inflammatory Syndrome in Children (MIS-C), a rare condition, has been reported approximately 2-4 weeks after the onset of COVID-19 in children and adolescents, causing inflammation in multiple systems, including cardiovascular and respiratory, digestive, and central nervous systems. This condition is also known as hyperinflammatory shock, Kawasaki-like disease, and Pediatric Inflammatory Multisystem Syndrome (PIMS). The signs and symptoms include but are not limited to fever, rash, peripheral edema, gastrointestinal symptoms, conjunctivitis, and shock. Thirty-eight studies met our criteria, with a total of 5822 patients. The most affected population was between 5-18 years of age. We noted that MIS-C presented with a wide range of signs and symptoms that overlap with Kawasaki Disease, including high fever, sore throat, malaise, tachypnea, tachycardia, conjunctival injection, mucosal edema, cardiac involvement, and gastrointestinal symptoms. It causes an increase in IL-17A, IL-6, and arterial damage, a distinct difference from Kawasaki disease. The laboratory findings in MIS-C showed an increase in inflammatory markers like CRP, ESR, ferritin, leukocytes, and TNF-α. WHO stated that 23% of affected children with MIS-C had underlying conditions like chronic lung diseases, cardiovascular disease, and immunosuppression. In most affected children, aspirin and IVIG were successful, which resulted in a decrease in the inflammatory markers. We find that MIS-C is a rare, but potentially fatal pediatric complication, after COVID-19 infection. The aim of this article is to study the emerging relationship between COVID-19 and MIS-C in children and adolescents affected by this condition, to discuss the immunological mechanisms, and explore potential therapies.

Research trends on causes of Kawasaki disease in the COVID-19 era: focus on viral infections.

Despite studies on the etiology of Kawasaki disease (KD) ongoing for half a century since its discovery, its cause has not yet been clearly identified. Although the clinical, epidemiological, and pathophysiological characteristics of KD are presumed to be closely related to infectious diseases, studies of various pathogens to identify its etiology have been actively conducted. To date, bacteria, fungi, and viruses have been investigated to determine the relationship between KD and infection, among which viruses have attracted the most attention. In particular, during the coronavirus disease 2019 pandemic, there were many reports in Europe of a sharp increase in cases of Kawasaki-like disease (KLD), while conflicting reports that the prevalence of KD decreased due to thorough "social distancing" or "wearing mask" in Asian countries drew more attention regarding the association between KD and viral infection. Therefore, the differential diagnosis of KD from KLD with these similar spectra has become a very important issue; simultaneously, research to solve questions about the association between KD and viral infections, including sudden acute respiratory syndrome coronavirus 2, is drawing attention again. Moreover, a new concept has emerged that immune responses occurring in patients with KD can be caused by the pathogen itself as well as host cells damaged by infection. This paper summarizes the research trends into KD etiology and related pathophysiology, especially its association with viral infections, and present future research tasks to increase our understanding of KD.

Management of Multisystem Inflammatory Syndrome in Children with Combined Use of Corticosteroids and Intravenous Immunoglobulin—Report from Bursa, Turkey

Abstract Objective In this article, we aimed to evaluate the clinical, laboratory, and radiological findings and outcomes of patients treated with corticosteroids and intravenous immunoglobulin (IVIG) with the multisystem inflammatory syndrome in children (MIS-C) in two centers in Bursa, Turkey. Methods We retrospectively collected the clinical characteristics, laboratory results, and treatment outcomes of MIS-C cases treated in two centers from April 2020 to February 2021. Patients were compared both according to their clinical categorization and the place they were hospitalized in, as well as with studies published in the literature. Results Fifty-six patients were included. Thirty-six (64.3%) were male with a mean age of 67.95 ± 50.87 months. Thirty patients (53.5%) were categorized as Kawasaki-like disease, 17 (30.3%) sepsis-like disease, and 9 (16%) were toxic shock syndrome (TSS). Admission symptoms were fever (100%), rash (71.4%), myalgia (69.6%), and abdominal pain (62.5%). Seventeen (30.3%) patients were hospitalized in pediatric intensive care unit. Elevated C-reactive protein levels, procalcitonin, erythrocyte sedimentation rate, D-dimer, and troponin were found in 100, 77, 84, 84, and 23.2% of the patients, respectively. Of all, 55 (98.2%) received IVIG, 54 (96.4%) corticosteroids, 56 (100%) antibiotic therapy, 22 (40%) albumin infusion, and 13 (23.2%) inotropic support. Fifty patients (89.3%) received low-molecular-weight heparin: enoxaparin, followed by acetylsalicylic acid treatment. Only one patient who was resistant to both IVIG and steroid treatment received Anakinra. One patient (1.7%) with TSS died within 1 hour of hospitalization. Conclusion Combined use of IVIG and corticosteroids is an effective way of treatment in MIS-C patients resulting in low mortality.

Incidental Finding of Coronary Artery Dilatation in Children With History of COVID-19 Having Minimal or No Symptoms: Raising Red Flag

Coronary artery dilatation has been observed with coronavirus disease 2019 (COVID-19)-associated multisystem inflammatory syndrome in children (MIS-C), which is more common in those with Kawasaki-like disease. MIS-C is a clinical syndrome in children and adolescents; its signs and symptoms, as well as cardiac manifestations, are similar to Kawasaki diseases, such as coronary artery dilation, coronary aneurysms, and ventricular dysfunction. The occurrence of coronary artery dilatation in asymptomatic pediatric patients following COVID-19 infection has not been well documented in the literature.Thus, in this article, we present four cases of coronary artery dilation in children with a past history of COVID-19 infection who had very few or no symptoms and were referred to us for vague chest pain and palpitation. As a result, a high index of suspicion is required, and any patient complaining of chest pain and palpitation with a history of COVID-19 exposure should not be ignored and be given proper coronary artery evaluation. This article also raises the question of whether every child infected with COVID-19 should have an echocardiogram.

Kawasaki-like disease in children with COVID-19

Sir, In late 2019, a new type of viral infection emerged in Wuhan, China, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) and which has become the most challenging pandemic of this century. COVID-19 has affected individuals of all ages worldwide. Epidemiological data from numerous countries show that children are a small minority of those who test positive. Most children with COVID-19 show mild symptoms or are asymptomatic, yet new concerns have emerged, with reports on hyperinflammatory states or Kawasaki-like disease [1,2]. Kawasaki disease (KD) is a systemic vasculitis of unknown etiology that occurs mainly in children and rarely in adults [3]. Herein, we report a child with Kawasaki-like disease associated with COVID-19. A fifteen-year-old boy presented to our department with a four-day history of high fever, vomiting, diarrhea, abdomen pain, and erythematous rash. His previous medical history was unremarkable. A physical examination revealed diffuse, erythematous, maculopapular rash, bilateral conjunctivitis, erosive hyperemia of the oral mucosa, scrotal erythema, and a deepithelialized tongue (Figs. 1 and 2).

Multisystem Inflammatory Syndrome in Children (MIS-C)

Purpose of ReviewThe novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has developed into a pandemic. A unique challenge of this pandemic has been the emergence of multisystem inflammatory syndrome in children (MIS-C), a rare post-infectious hyperinflammatory disorder associated with SARS-CoV-2. This syndrome is characterized by overwhelming systemic inflammation, fever, hypotension, and cardiac dysfunction. This disorder may also have features overlapping with Kawasaki disease (KD), macrophage activation syndrome (MAS), and toxic shock syndrome (TSS). The goal of this review is to outline the presenting features, presumed immunopathogenesis, management, and outcomes of patients with MIS-C.Recent FindingsPatients with MIS-C present with characteristics that fall within a wide clinical spectrum. Main features include fever, gastrointestinal symptoms such as abdominal pain and diarrhea, and cardiac complications such as myocarditis and coronary artery aneurysms, although various other features have been reported. Younger children may present with features of Kawasaki-like disease, and older children are often admitted to the intensive care unit with cardiogenic shock. Current treatment guidelines recommend intravenous immunoglobulins (IVIG) and glucocorticoids, with utilization of biologics in refractory cases. Fortunately, the majority of patients recover, with resolution of the systemic inflammation and cardiac abnormalities. Mortality from MIS-C is rare.SummaryThis review provides an overview of the presenting features, proposed pathogenesis, suggested therapies, and outcomes of MIS-C. Clinicians must have a high clinical suspicion for this disorder in children who have had recent COVID-19 infection or exposure and present with a significant inflammatory response. Understanding of this disorder continues to evolve, and prompt diagnosis and treatment allow for the best possible outcome for patients with MIS-C.

Adult-onset Kawasaki-like disease as a paraneoplastic syndrome.

Adult-onset Kawasaki-like disease as a paraneoplastic syndrome.

Scales of Magt1 Gene: Novel Mutations, Different Presentations

Loss-of-function mutations in magnesium transporter 1 (MAGT1) gene cause X-linked magnesium deficiency with Epstein-Barr virus (EBV) infection and neoplasm (X-MEN), a disease with quite diverse clinical and immunological consequences. The phenotypic characteristics of the initially described patients included CD4+ T cell lymphopenia, immune deficiency, EBV viremia, and EBV-related lymphoproliferative disease. To date, a total of 25 patients have been reported. The spectrum of the MAGT1 defect ranges from other viral infections (HSV, VZV, CMV, MCV) and sinopulmonary bacterial infections, autoimmune diseases, non-EBV driven lymphoproliferative disease, Castleman disease, HHV8+ Kaposi's sarcoma, vasculitis (Kawasaki) to glycosylation defects in new patients. Here, we report 2 patients from two different families with novel MAGT1 mutations and different clinical features. The first patient presented with B cell lymphoma and low IgM level without recurrent infections. The second patient presented with recurrent upper respiratory tract infections, Kawasaki-like disease, hypogammaglobulinemia, and T cell lymphopenia. X-MEN disease is the first phenotype identified due to MAGT1 mutation. The identification of new mutations and atypical presentations will clarify whether there is a relationship between the genotype and the phenotype and the characteristics of the disease.

COVID-19-Associated Multisystem Inflammatory Syndrome in a Neonate with Atypical Coronary Artery Involvement.

The study aimed to report a novel coronavirus disease 2019 (COVID-19)-associated multisystem inflammatory syndrome in children (MIS-C) in a neonate found to have an atypical diffuse thickening in coronary artery walls whose diagnosis required a multi-imaging approach. A neonate presented at birth with multiple organ involvement and coronary artery anomalies. A diagnosis of MIS-C associated with COVID-19 was supported by maternal severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy, and by the presence of both immunoglobulin (Ig)-G against SARS-CoV-2 and spike-specific memory B-cells response in the neonatal blood. Other plausible causes of the multiple organ involvement were excluded. At admission, a severe coronary artery dilatation was identified on echocardiography, supporting the diagnosis of the MIS-C Kawasaki-like disease; however, coronary artery internal diameters were found to be normal using cardiac computed tomography angiography. At discharge, comparing the two imaging techniques each other, the correct diagnosis resulted to be an abnormal thickening in coronary arterial walls. These findings suggest that the inflammatory process affecting the coronary arterial wall in MIS-C could result not only in typical coronary artery lesions such as dilatation of the lumen or aneurysms development but also in abnormal thickening of the coronary artery wall. Our case provides an alert for pediatric cardiologists about the complexity to assess coronary artery involvement in MIS-C and raises the question that whether an abnormal vascular remodeling, with normal inner diameters, is to be considered like coronary artery dilatation for risk stratification. · COVID-19 associated MIS-C can present in neonates with multiple organ involvement.. · Coronary artery assessment in neonatal MIS-C could be complex, and a multi-imaging approach could be required.. · Beside the typical coronary artery lesions, such as dilatation of the lumen or aneurysms, also abnormal thickening of the coronary artery wall can occur..

Oral Manifestations of COVID-19

Since the inception of COVID-19 pandemic in November 2019, caused by SARS-CoV-2 virus, relationship between corona virus disease and oral effects caused due to viral enanthema have been studied with great interest. Owing to the existence of many ACE2 receptors (which permit entry of virus in the host cell) in the oral cavity, a multitude of oral manifestations have been described. Among various oral symptoms, dysgeusia is the most prevalent. Other oral lesions included ulcer, erosion, vesicle, bulla, depapillated tongue, macule, papule, plaque, pigmentation, whitish areas, petechiae and erythema. Aphthous stomatitis, mucositis were also diagnosed among COVID-19 affected patients. Kawasaki-like disease and atypical Sweet syndrome was also noted in some patients. People with severe disease state and older individuals had significantly more oral lesions. Many oral symptoms were seen in patients post the corona virus disease recovery as well. This may be due to the diverse treatment given to the patients which may have ill-effects. Older age group, underlying diseases, opportunistic infections, poor oral hygiene and stress are the important factors for the development of oral manifestations in COVID-19 patients. Health care workers should be vigilant to identify the various oral manifestations and provide extensive treatment with an intent to improve general status as well as oral health of COVID affected individuals.

Paradigm shift in MIS-C – the case of a perfect storm

Acute renal infarction in pediatric patients is a rare oc­cur­rence, usually associated with cardiac anomalies, hyper­coagulable state, diseases with local thrombotic potential, systemic infections, or autoimmune diseases. Following the COVID-19 pandemic, the medical scientific community established diagnostic criteria for PIMS-TS (Pediatric In­flam­matory Multisystem Syndrome – temporally as­so­cia­ted with SARS-CoV-2), also known as multisystem inflamma­to­ry syndrome in children (MIS-C), a condition found in chil­­dren exposed to the new type of coronavirus. Three cli­­ni­­cal phenotypes have been established: toxic shock syn­­drome, Kawasaki-like disease, and undefined in­flam­ma­tory presentation. Cardiovascular manifestations were con­si­dered prominent in all clinical scenarios, while renal and neurologic involvement played a secondary role. There is, however, mounting evidence suggesting that MIS-C is in fact a miscellaneous pathology and that a focus change is war­ranted.