key: cord-0905125-swrvvyh2 authors: Jafarpour, Shahin; Abedini, Masoumeh; Saburi, Amin title: Kawasaki Disease and COVID-19; a pretext for a hot topic date: 2020-12-03 journal: J Formos Med Assoc DOI: 10.1016/j.jfma.2020.11.016 sha: b1f42d38a08357e58bad7677ebf1e9a39aabbf34 doc_id: 905125 cord_uid: swrvvyh2 nan Initially, the disease has not been enough considered in children because "the vast majority of infected children have mild or unrecognized disease". [2] Although various presentations of this disease were frequently published, cardiac and non-pulmonary features of SARS-Cov2 in pediatrics population were not fully identified. [1, 3] Recently, a possible correlation between Kawasaki disease (KD), as an autoimmune disorder with mucocutaneous-lymph node involvement, and COVID-19 in pediatrics has been raised. [4] [5] [6] We also would like to present a relevant case with the mentioned possible association to help researcher to find more aspect of this disease. J o u r n a l P r e -p r o o f A 7-year-old girl presented to our tertiary pediatrics health care service with fever and skin rash since 4 days. At first look there is thrombocytopenia in cell blood count (platlete 50,000). The patient was examined for fever (temperature 39 oc) and extensive maculopapular lesions in the abdomen and back that were slightly itchy. Coetaneous erythema of the fingers without edema, as well as individual similar lesions on the knees and legs (Figure-1) , a slight red sclera, and a slight erythematic lips & throat were found in physical examination. Other examinations were normal. From 3 days ago, the patient had several vomiting and decreased appetite and pain in her lower abdomen, and from the previous day of presentation to our hospital, she mentioned the elimination of watery diarrhea once. Two days after admission, abdominal distension and pain and also respiratory distress is appeared. Chest CT scan to assess for COVID-19 with was epidemic in our region was done and the following findings were seen; peripheral & bilateral ground glass opacities in lower lobes, cardiomegaly, pleural effusion in both side and free fluid at upper abdominal slides, prominent pulmonary arteries, bilateral central pribronchial cuffing ( Figure-2 a,b) . Although bilateral GGO was compatible with COVID-19 [7] , the 4 recent findings support another diagnosis in addition to COVID-19 induced cardiac edema such as KD. Therefore the patient was undergone echocardiography and the findings On the other hand, it was previously reported that "some common respiratory viruses, such as adenoviruses, enteroviruses, rhinoviruses, and coronaviruses, were associated with KD cases". [9] A cross reaction between viral/bacterial antigen and vascular endothelial antigen is a strong hypothesis about KD and infectious diseases. [10] Moreover, defect in maturation of immune system in response of an infectious agent to induce KD is another one. Likewise, it was reported that "Kawasaki disease J o u r n a l P r e -p r o o f may result from an abnormal clonal expansion of CD8+ T cells in response to an infectious agent and therefore, predisposition of the host, in addition to the antigenic properties of the virus, may play an important role in the vasculitis of Kawasaki disease". [11] Finally, the worrying point is that; there are some nationwide epidemics in Japan were reported after bacterial/viral infections and therefore, we will probably have to wait for a major global epidemic of KD after the peak of COVID-19 subsides. There is evidence for this claim; the association between SARS-Cov1 and KD previously declared at 2005. [12] There are some suggestions for further studies to confirm or reject this hypothesis; first of all, a cross sectional study conducted on KD cases for suspected symptoms of Covid-19 (an epidemiologic study). Then confirm the correlation between Corona virus 2019 antigen/ antibody titer and KD prevalence and a controlled matched group without KD. Finally, assess the relationship between the severities of the KD with COVID-19 severity. An experimental in vitro study should be conducted on Rats infected with Covid-19 virus and followed for similar symptoms of KD. Until the final correlation was declared, it was suggested that follow the new cases of COVID-19 for avid or subtle symptoms of KD and then exclude the overlap diseases such as Juvenile rheumatoid arthritis, Scarlet fever, etc and also check the B-type SARS-CoV-2 infection in children: Transmission dynamics and clinical characteristics Symptomatic and Asymptomatic Viral Shedding in Pediatric Patients Infected With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Under the Surface The First Presentation of Pediatric COVID-19 With Diabetic Ketoacidosis: A Unique Case Report Kawasaki-like disease in children with COVID-19 Multisystem inflammatory syndrome in children: Is there a linkage to Kawasaki disease? Trends in cardiovascular medicine The novel coronavirus (COVID-19) and the risk of Kawasaki disease in children Rings of Saturn" appearance: a unique finding in a case of COVID-19 pneumonitis COVID-19: consider cytokine storm syndromes and immunosuppression. The Lancet Viral infections associated with Kawasaki disease The role of infections in the pathogenesis of autoimmune diseases Association between a Novel Human Coronavirus and Kawasaki Disease. The Journal of Infectious Diseases Autoimmune Aspects of Kawasaki Disease Usefulness of natriuretic peptide for the diagnosis of Kawasaki disease: a systematic review and meta-analysis