Incomplete Kawasaki Disease as Presentation of COVID-19 Infection in an Infant: A Case Report

Abstract

Background Recently a severe form of COVID-19 infection has been described in a cluster of children presenting as multisystem inflammatory condition. One of the important spectrum of this condition is incomplete Kawasaki disease (KD). Case report A 5-month-old male child presented with high-spiking fever for 5 days with skin rash, bilateral non-purulent conjunctivitis and irritability. His C-reactive protein was markedly elevated (215.4 mg/l). Echocardiography revealed dilated left main coronary artery (3.0 mm, Z score +4.30) and left anterior descending artery (2.37 mm, Z score +3.76). Concomitantly Reverse Transcription- Polymerase Chain Reaction for COVID-19 was positive on fifth day sample. He was diagnosed as incomplete KD with COVID-19 infection and treated with intravenous immunoglobulin (IVIG) (2 g/kg), oral aspirin and azithromycin. Patient improved after 48 h and was discharged on oral aspirin. Conclusion Incomplete KD may co-exist with COVID-19 infection in infant. Early institution of IVIG may lead to better outcome.

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

“… Atypical KD IVIg, glucocorticoids, ASA N.A. [ 207 ] 1 (confirmed) M 19y Atypical KD None Recovered [ 208 ] 31 (30 confirmed) 18 M 13 F 7.6y MIS-C/KD 20 IVIg, 21 glucocorticoids, 1 Death 3 Coronary artery abnormalities [ 209 ] 1 (confirmed) M 16y PIMS-TS shock IVIg, glucocorticoids, ASA Recovered Coronary aneurysm [ 210 ] 1 (confirmed) M 5m Atypical KD IVIg, ASA Recovered Coronary artery abnormalities [ 211 ] 2 (all confirmed) N.A. N.A.…”

Cutaneous and histopathological features of coronavirus disease 2019 in pediatrics: A review article

“…If there are two or three other clinical features of the disease, echocardiography and electrocardiography should be performed immediately. Furthermore, myocardial markers (troponin and N‐terminal pro b‐type natriuretic peptide), acute inflammatory reactants (CRP, ESR, procalcitonin, and ferritin), coagulative markers (prothrombin time, partial thromboplastin time, and d ‐dimer), renal function test (urea, creatinine, and proteinuria), and RT‐PCR for SARS‐CoV‐2 from nasopharyngeal and stool and serology tests should be performed to assess the involvement of other organs and detection of the culprit cause 16,20,22,24,29,36,40,45 …”

Contributing factors to pediatric COVID-19 and MIS-C during the initial waves: A systematic review of 92 case reports

“…Case definitions: MIS-C associated with COVID-19 (WHO) [ 5 ]; MIS-C associated with COVID-19 (US CDC) [ 17 ]; PIMS-TS (RCPCH) [ 134 ]; Complete Kawasaki disease (AHA) [ 135 ]; Incomplete Kawasaki disease (AHA) [ 135 ]. Case Definitions First author Country Age Positive contact history Gender Signs and symptoms at presentation Lag time MIS-C Associated with COVID-19 (WHO), and Complete Kawasaki Disease (AHA) Loo [ 118 ] Hong Kong 4 months NA Male Fever, bilateral conjunctivitis, congested throat with bright red tongue and lips, diffuse maculopapular rash over the face, trunk, limbs, and swelling with erythema over bilateral hands and feet 5 days MIS-C Associated with COVID-19 (WHO), and Incomplete Kawasaki Disease (AHA) Raut [ 119 ] India 5 months Parents Male Fever, irritability, upper extremities, and trunkal maculopapular rash, and conjunctivitis 5 days Complete Kawasaki Disease (AHA) Jones [ 120 ] USA 6 months None Female Fever, refusal to eat, maculopapular rash, and bulbar conjunctival injection without exudate, and upper extremity erythema and edema 5 days MIS-C Associated with COVID-19 (WHO), MIS-C associated with COVID-19 (US CDC), and Incomplete Kawasaki Disease (AHA) Loo [ 118 ] Hong Kong 6 months NA Male Fever, left cervical lymphadenopathy with abscess formation, faint maculopapular rash over trunk sparing the extremities 6 days MIS-C Associated with COVID-19 (WHO), MIS-C associated wi...…”