P0472 - Kawasaki disease following COVID-19 infection in a 5-year-old girl

Introduction: Kawasaki disease (KD), an acute syndromic systemic vasculitis of unknown cause, usually follows a viral infection. However, the link between KD and COVID-19 is not well established. Here, we report a 5-year-old girl who developed KD during convalescent phase of COVID-19 infection.

Case Description: A 5-year-old girl with no past medical history presented with a 10-day-history fever (Tmx 104.3F) associated with abdominal pain, dry cracked lips, conjunctivitis, generalize erythematous macular rash involving palms and soles, and swelling of hands and feet. On admission, patient’s vital signs were stable except for fever (T 102). She fulfilled the diagnostic criteria for KD. Her laboratory screen showed WBC, 5,000/ul; platelet, 483,000/ul; ESR, 81 mm/h; CRP; 22 mg/dl; Sars-Cov-2 RNA (RT-PCR) negative. Echocardiogram revealed left coronary artery ectasia. Patient received a single dose of intravenous immunoglobulin (IVIG) and aspirin with a good response. Despite negative history of sick contact, COVID-19 serology test was performed which showed a positive IgG and a negative IgM titer, suggestive of convalescent phase of the viral infection.

Discussion: Recent data showed that many children with KD were tested negative for COVID-19, suggesting no increased incidence or susceptibility to COVID-19 infection for patient with KD. With increasing utilization of COVID-19 serology testing, evidence of association between the virus and KD may start emerging. Both COVID-19 infection and KD can exhibit hyperinflammatory state involving multi-systems. Our patient’s positive serology, fever and gastrointestinal symptoms indicated that her development of KD was preceded with COVID-19 infection, portending a potential role of systemic immune response triggered by the virus in KD pathogenesis.

Conclusion: Clinicians should be vigilant for this possible new association between COVID-19 and KD. Clinical criteria for testing for COVID-19 must not be restricted to those with respiratory symptoms. We recommend both RT-PCR based and serology test for the virus be utilized in patient with KD.