key: cord-0877713-u8xumgep
authors: Khan, Kiran Shafiq; Ullah, Irfan
title: SARS‐CoV‐2 causes Kawasaki‐like disease in children: Cases reported in Pakistan
date: 2020-08-02
journal: J Med Virol
DOI: 10.1002/jmv.26340
sha: a5a89064a753b11653dd7d3561a798e646f36c8c
doc_id: 877713
cord_uid: u8xumgep

The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease, has spread promptly globally. In adults, COVID-19 shows classic symptoms that range from severe interstitial pneumonia to hyper-activation of the inflammatory cascade. In children, respiratory involvement is mild and has a non-threatening course, with almost no mortalities. This article is protected by copyright. All rights reserved.

The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease (COVID), has spread promptly globally. 1, 2 In adults, COVID-19 shows classic symptoms that range from severe interstitial pneumonia to hyperactivation of the inflammatory cascade. 3 In children, respiratory involvement is mild and has a nonthreatening course, with almost no mortalities. 4 Recently, many cases of post-COVID inflammatory syndrome are being reported in Karachi, Lahore, and Islamabad/Rawalpindi, Pakistan. 4 It is also known as Kawasaki-like multisystem inflammatory, 5 it named because of some similar symptoms with the other rare childhood conditions Kawasaki disease such as skin rash, lymphadenopathy, strawberry tongue, and elevated inflammatory biomarkers. 6 The association between COVID-19 and Kawasaki-like multisystem inflammatory syndrome in children (MIS-C) is not well understood. 6 The incidence of post-COVID inflammatory syndrome is 1 of 1000 children affected by COVID-19. 7 In the present case report, we present a rare and unique manifestation of COVID-19-related Kawasaki symptoms in Pakistani children.

As per news report, eight cases of Kawasaki-like multisystem inflammatory syndrome that are associated with COVID-19, have been reported in children between the ages of 5 to 15 years at Children Hospital, Lahore. 5 All the affected children have been tested positive for coronavirus antibodies. They either have been recovered from COVID-19 or have been around someone with COVID-19.

Children presented with this condition are very ill and show signs and symptoms of inflammation in many internal organs, such as the intestines, heart, lungs, and kidneys. Thus, overlapping with toxic shock syndrome and Kawasaki disease shock syndrome are presented. 5 News reports are also proposed that fever (for more than 3 days), stomach ache, vomiting, diarrhea, red eyes, and rashes on the trunk are the most common presenting complains. A few of the children are presented with a low blood pressure, cold hands, and feet suggestive of shock. 5 Among them one or two develop inflamed red spots on mouth and tongue while only a few have swollen glands in the neck.

It has also been reported that due to inflamed blood vessels, blood carrying capacity of vessels have significantly reduced. Post-COVID-19 syndrome puts a strain on the heart and compromises its ability therefore children with heart involvement require mechanical ventilation. 5 Though the condition has gotten better with medical care with intravenous immunoglobulin (IVIG), steroids, and high dose aspirin. Supportive treatment and assisted ventilation are required for the heart and lungs stabilization. 5 Kawasaki-like MIS-C with combination of COVID-19 syndrome overlaps the typical symptoms of Kawasaki disease. 8 Outside Pakistan, the very first case of Kawasaki-like multisystem inflammatory was reported on 26 April 2020, in the United Kingdom. 9 A COVID-19 recovered child presented with a severe inflammatory syndrome that has some common features as in Kawasaki disease. 9 Further, eight cases were reported with the complaint of persistent fever, hypotension, and multiorgan (cardiac, gastrointestinal, renal, hematologic, dermatologic, and neurologic) involvement, and all of them have elevated inflammatory markers. 10 Respiratory symptoms were mild or not present in all cases. 10, 11 Over time, more similar cases have been reported by authorities of different countries whereas children are being presented with the severe inflammatory syndrome and also have a laboratory-confirmed case of COVID-19 or an epidemiological link to the COVID-19 case. 1 Three cases of Kawasaki-like multisystem inflammatory syndrome in teenagers of Afro-Caribbean and Asian ethnic background have been reported. 12 In correspondence to our case, all three patients presented with fever, conjunctivitis, and gastrointestinal symptoms 12 They were also tested positive for SARS-CoV-2 immunoglobulin G with elevated inflammatory markers.

Their labs result indicate low platelet count, prolonged prothrombin time, and activated partial thromboplastin time. 12 In this study two

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