Kawasaki-like disease in children with COVID-19
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Rheumatology International https://doi.org/10.1007/s00296-020-04701-6
INTERNATIONAL
CASE BASED REVIEW
Kawasaki‑like disease in children with COVID‑19 Ummusen Kaya Akca1 · Selman Kesici2 · Yasemin Ozsurekci3 · Hayrettin Hakan Aykan4 · Ezgi Deniz Batu1 · Erdal Atalay1 · Selcan Demir1 · Erdal Sag1 · Dogus Vuralli5 · Benan Bayrakci2 · Yelda Bilginer1 · Seza Ozen1 Received: 11 July 2020 / Accepted: 3 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Children with Coronavirus disease 2019 (COVID-19) are being reported to have manifestations of hyperinflammatory states and/or Kawasaki-like disease. In this study, we investigated children with typical and atypical Kawasaki disease (KD) likely to be associated with COVID-19. We have reported four children with Kawasaki-like disease probably associated with COVID-19. The clinical features were consistent with incomplete KD in three patients. SARS-CoV-2 RT-PCR was positive in one and the serology was positive in one patient with negative RT-PCR. Corticosteroids, anakinra, intravenous immunoglobulin (IVIG), and acetylsalicylic acid were used in the treatment. Three patients recovered after the treatment while one patient died. The literature review revealed 36 articles describing 320 children with Kawasaki-like disease associated with COVID-19. SARS-CoV-2 RT-PCR was negative in 120 (65.5%) of 183 patients while the serology was positive in 130 (83.8%) of 155 patients. The therapeutic options have included IVIG, acetylsalicylic acid, tocilizumab, anakinra, enoxaparin, and methylprednisolone. Pediatric COVID-19 cases may present with atypical/incomplete Kawasaki-like disease. Thus, pediatricians need to be aware of such atypical presentations resembling KD for early diagnosis of COVID-19. Keywords COVID-19 · Kawasaki-like syndrome · 2019 novel coronavirus diseases · SARS-CoV-2 · Kawasaki disease
Introduction Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected individuals of all ages worldwide. Children constituted only a small proportion of patients with COVID-19, * Seza Ozen [email protected] 1
Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
2
Division of Pediatric Intensive Care Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
3
Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
4
Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
5
Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
which was initially reported as 1.7% [1]. The actual incidence is unknown since there are no community-based studies. While more than 90% of children with COVID-19 were described to have asymptomatic, mild, or moderate disease
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