Discovering Associations: Kawasaki Disease and COVID-19

Abstract

The COVID-19 pandemic has resulted in over 3.6 million confirmed cases and over 254,000 deaths worldwide. It has been theorized that children who are asymptomatic or who do not display significant respiratory symptoms are potential vectors for community transmission of the SARS-CoV-2 virus. This is incompletely understood due to the current lack of widespread testing in the pediatric population. We describe a case of a 2-year-old female who presented with symptoms of prolonged fever, conjunctivitis, extremity edema, rash, dry/cracked lips, fussiness and fatigue, and a notable absence of respiratory symptoms. She was diagnosed with and treated for Kawasaki disease. Due to her prolonged fever, she was tested for COVID-19 which was positive; however, she did not develop respiratory symptoms during her illness. At the time of manuscript submission, this is the second case report to our knowledge showing an association between Kawasaki Disease and SARS-CoV-2 virus, both of which are poorly understood diseases in the pediatric population. This case highlights the value of testing pediatric patients for COVID-19 who present with fever in the absence of other symptoms to improve epidemiologic measures during the ongoing pandemic, and it also adds to a foundation of cases for future research on the presence of a link between Kawasaki Disease and COVID-19.

COVID‐19‐related oral mucosa lesions among confirmed SARS‐CoV‐2 patients: a systematic review

“…We categorized the reported oral mucosa findings into three subgroups: KWL: Kawasaki‐like syndrome‐associated oral mucosa findings (cracked lips, dry lips, cheilitis with/without erythema of oral mucosa; Table 3). 11,13–16,19–21,25,28,30,32,35–39,41,44,45,48,49 OU: Ulcers in the oral mucosa (aphthous, herpetiform, multiple, single, necrotizing; Table 4). 17,18,22,24,26,27,29,33,40,42,43,46,49,50 M: Miscellaneous group (macular, papular, pustular, bullous, and overlapping cases; Table 5).…”

A case of classical Kawasaki disease with severe acute respiratory syndrome coronavirus 2 infection in Japan

“…This is known as multisystem inflammatory syndrome in children (MIS‐C) and has a pathogenesis different from that of classical Kawasaki disease. However, there are only a few reports of patients with classical Kawasaki disease with concurrent SARS‐CoV‐2 infection 2 . Here, we report such a case of pediatric classical Kawasaki disease with SARS‐CoV‐2 infection.…”

“…Therefore, cases of Kawasaki disease that develop at the same time as SARS‐CoV‐2 infection could become severe. However, in our patient, as in previous reports, 2 the symptoms of Kawasaki disease improved rapidly with standard treatment. This might suggest that SARS‐CoV‐2 infection is less likely to overactivate the immune system both in normal children and those with Kawasaki disease.…”

Asymptomatic COVID-19 infection: diagnosis, transmission, population characteristics

“…Also, some children are often accompanied by symptoms such as rhabdomyolysis and acute renal failure. 42 These atypical symptoms should be addressed to optimise early identification and hospital management of the child.…”