The wide spectrum of Kawasaki-like disease associated with SARS-CoV-2 infection

Expert Rev Clin Immunol. 2020 Dec;16(12):1205-1215. doi: 10.1080/1744666X.2021.1847643. Epub 2020 Nov 25.

Abstract

Introduction: On June 2020, the first case of concurrent Covid-19 and Kawasaki disease (KD) was published. After this first description, further works reported new cases of children affected by KD and KD-like syndrome after SARS-CoV-2 infection. The clinical and biochemical features of these patients differed from the historical cohorts of KD, suggesting the possibility of a new multi-systemic inflammatory syndrome. Is still unclear if this new clinical entity, often referred as pediatric inflammatory multisystem syndrome (PIMS) or multi-system inflammatory syndrome in children (MIS-C), could be considered as part of the KD spectrum or is a new disease with different pathogenic mechanisms and uniquely linked to SARS-CoV-2 infection. The authors searched the available literature in MedLine (via Pubmed) with the terms ('coronaviruses' OR 'coronavirus') AND ('Kawasaki disease') for English studies without any temporal limit. Areas covered: This review aims to comprehensively describe multisystem inflammatory syndromes affecting children during Coronaviruses outbreak, and to evaluate the possible pathogenic role of human Coronaviridae in KD and KD-like syndromes. Expert opinion: An increased incidence of PIMS-TS, during the Covid-19 pandemic has been reported, suggesting that SARS-CoV-2 may trigger a severe hyper-inflammatory syndrome in childhood. The pathophysiological mechanisms of this disease are still unclear. Based on these findings, SARS-CoV-2 may be considered another trigger in the complex mosaic about the relationship among infectious agents and the occurrence of systemic hyper-inflammation related syndromes.

Keywords: Covid-19; Kawasaki disease; Kawasaki-like disease; Multisystem inflammatory syndrome; SARS-CoV-2; children.

Publication types

  • Systematic Review
  • Video-Audio Media

MeSH terms

  • COVID-19* / epidemiology
  • COVID-19* / immunology
  • COVID-19* / pathology
  • Child
  • Humans
  • Mucocutaneous Lymph Node Syndrome* / epidemiology
  • Mucocutaneous Lymph Node Syndrome* / immunology
  • Mucocutaneous Lymph Node Syndrome* / pathology
  • Pandemics*
  • SARS-CoV-2 / immunology*
  • Systemic Inflammatory Response Syndrome* / epidemiology
  • Systemic Inflammatory Response Syndrome* / immunology
  • Systemic Inflammatory Response Syndrome* / pathology

Supplementary concepts

  • pediatric multisystem inflammatory disease, COVID-19 related