Comment on: COVID-19 linked to outbreak of severe Kawasaki-like disease
The article by Verdoni et al reports on the Italian experience of severe Kawasaki-like disease during the SARS-CoV-2 epidemic. Strikingly, the authors report a surge of children with Kawasaki syndrome during this epidemic time with 10 patients presenting between February and April 2020 compared with 19 patients between Jan 2015 and February 2020.
For me as a pediatric rheumatologist, there are some important differences between these two cohorts. The children presenting during the COVID-19 epidemic were more ill. In particular, signs of macrophage activation syndrome were seen in 50% of children presenting during the COVID-19 period compared with 0% in years prior. This is important for pediatric rheumatologists to be aware of, particularly if IVIG is not successful to control initial symptoms. Immune modulating therapies such as IL-1 or IL-6 inhibitors may be useful to control the cytokine storm in the COVID cohort.
The other important point for pediatric rheumatologists to be aware of is the increased risk for cardiac involvement. The cohort during the COVID epidemic had increased echocardiogram abnormalities and abnormal cardiac enzymes compared with prior years. Pediatric rheumatologists will need to work closely with their cardiology colleagues to assess long-term outcomes in these children.
Eighty percent of children in the COVID-19 cohort were positive for IgG antibodies and one was positive for IgM antibodies to SARS-CoV2. This suggests that the immune response to the SARS-CoV2 may be driving the Kawasaki presentation. For pediatric rheumatologists, this potential for causative agents in Kawasaki could be a breakthrough in understanding this complex disease. These data could also lead to potential treatments, such as vaccines to certain viruses, instead of our traditional immune modulating therapy.
It will be important for pediatric rheumatologists to continue to work together to study and treat children with Kawasaki-like syndrome in the COVID-19 era.
19 May 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.