Novel Coronavirus Mimicking Kawasaki Disease in an Infant
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Novel Coronavirus Mimicking Kawasaki Disease in an Infant
culture, but fever continued till the third day of admission, when he developed non-purulent conjunctivitis with left subconjunctival hemorrhage. Repeat CRP showed a higher value of 178.2 mg/L. With evolving clinical signs simulating Kawasaki disease, an echocardiography was performed. It showed normal left ventricular function, perivascular brightness and diffuse ectasia of coronary arteries with left middle coronary artery (LMCA) of 2.7 mm (Z score +2.6) (Fig. 1a), left anterior descending artery of 2 mm (Z score +2.9) and proximal right coronary artery (RCA) of 2.4 mm (Z score +3.6) (Fig. 1b). Oral aspirin (80 mg/kg) and intravenous immune-globulin (IVIG) (2 g/kg) therapy was started. He stayed stable clinically and did not need intensive care. Fever subsided after 24 hours of finishing IVIG infusion, and the child became playful. Subsequently, SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) showed a positive result and he was shifted to a COVID-designated hospital. All cultures were negative till 7 days. Repeat blood test revealed a downward trend of CRP (148 mg/L). Swab for other viruses was negative. To date the baby is stable, afebrile, and is kept under observation in the pediatric ward. His mother was also subsequently found positive for SARS-CoV-2.
C
oronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) uncommonly causes severe disease in children [1]. Over the last two months; however, a new hyper inflammatory condition manifesting as Kawasaki disease or Kawasaki-like shock syndrome has been described in children above 4 years of age, across Europe and USA [2-4], with increased risk of mortality. One case from India has also been reported [5]. Here we report an infant presenting with fever and clinical manifestations of Kawasaki disease and subsequently screening positive for COVID-19.
A 4-month-old healthy baby, weighing 5.6 kg, and born to non-consanguineous parents, presented with high-grade fever for 4 days. Fever was spiking 6-8 hourly reaching 39 0C. He developed an erythematous macular rash over the trunk, palm and sole on second day. On admission the child was hemodynamically stable and was breastfeeding normally. He was very irritable with red lips, congested throat and small cervical lymphadenopathy without any cough or nasal congestion. He had clear chest, normal regular heart sounds and a saturation of 97-98% in air. Investigations revealed a hemoglobin of 9.9 g/dL, total leucocyte count of 14770/mm3 with 50% neutrophils, platelet count 4.25×109/L, C-reactive protein (CRP) of 115.6 mg/L, normal liver enzymes with albumin 30 g/L and globulin of 22 g/L, and a normal chest X-ray. His nasopharyngeal swab was sent for SARS-CoV-2 RT-PCR and other viral PCR tests. Treatment was started with meropenem and vancomycin after sending blood and urine
Children of all ages can acquire COVID-19, although they appear to be affected less commonly than adults [1,6,7]. The most common
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