COVID-19 and relapsing Kawasaki disease: A case report during the pandemia

Introduction: The pandemia of COVID-19 remains a global health alarm with high incidence of lethality, especially in older age groups who suffer from underlying medical conditions However, children are less likely to manifest severe conditions Objectives: COVID-19 was correlated to a higher incidence and a suspected increased risk of Kawasaki Disease (KD) in children Methods: We describe the case of a 2 2-year-old infant admitted for fever (\u003e5 days;\u003e 39°C), pharyngitis, cheilitis, arthralgia, feet oedema, rash, perineal and scrotal region erythema, bilateral lymphadenopathy of the neck, cough, rhinorrhea He was extremely irritable Heart rate: 140/min;capillary saturation 99 % in air Laboratory tests showed: leukocytes 13 4 x 103/μ l (neutrophils: 7 4 x 103/μ l);platelets 502 x 103/μ l;haemoglobin 11 1 g/dl;increased inflammatory markers, with C-reactive protein (CRP) of 14 7 mg/dl (n v : \u003c 0 5);hyponatremia (133 mEq/l) The nasal swab for respiratory viruses, IgM and IgG anti-EBV, CMV, Parvovirus, Mycoplasma, Chlamydia were negative Anamnestic records revealed a previous KD, without coronary artery lesions (CAL), 1 year before Results: He was treated with antibiotics, intravenous infusion of Immunoglobulins (IVIG) (2 gr/Kg), acetylsalicylic acid (ASA) (50 mg/Kg in 4 doses/day) and reached defervescence into 2 days Echocardiography excluded CAL The nasopharyngeal swab for SARS-COV-2 was doubt The second throat swab done the day after IVIG infusion, was negative;however, the third nasopharyngeal swab for SARS-COV-2, done 4 days after IVIG infusion, was positive Chest X-ray showed a significant lung interstitial thickening IL-6 levels were \u003c 6 25 pg/ml (n v \u003c 6 25 pg/ml) He continued treatment with antibiotics, ASA (5 mg/Kg/day), with the progressive resolution of the clinical symptoms and of the normalization of laboratory findings Conclusion: The peculiar outcome of the patient is the correlation of COVID-19 with KD, recently reported as associated KD is considered as a multifactorial autoinflammatory disease, induced by a cytokine hypersecretion with a systemic vasculitis COVID-19 is considered a cytokine storm syndrome, with a severe systemic vasculitis SARS-COV-2 infection could be the trigger that could lead to hyperinflammation of KD The IVIG infusion could explain the transient negative swab for SARSCOV-2, with the successive positive relieve lasting 7 days, and the normal levels of IL-6, detected after IVIG infusion Relapsing KD is rare (1 7-3 5%);in our patient this event could be triggered by the documented SARS-COV-2 infection