Ann Rheum Dis
. 2020 Jun 11;annrheumdis-2020-217960.
doi: 10.1136/annrheumdis-2020-217960. Online ahead of print.
Paediatric Multisystem Inflammatory Syndrome Temporally Associated With SARS-CoV-2 Mimicking Kawasaki Disease (Kawa-COVID-19): A Multicentre Cohort
Marie Pouletty 1 2 , Charlotte Borocco 3 4 , Naim Ouldali 1 5 , Marion Caseris 1 6 , Romain Basmaci 7 8 , No?mie Lachaume 7 8 , Philippe Bensaid 9 , Samia Pichard 9 , Hanane Kouider 10 , Guillaume Morelle 11 , Irina Craiu 12 , Corinne Pondarre 13 , Anna Deho 14 , Arielle Maroni 14 , Mehdi Oualha 15 , Zahir Amoura 16 17 , Julien Haroche 16 17 , Juliette Chommeloux 18 , Fanny Bajolle 19 , Constance Beyler 20 , St?phane Bonacorsi 6 8 , Guislaine Carcelain 21 , Isabelle Kon?-Paut 3 4 , Brigitte Bader-Meunier 22 23 , Albert Faye 1 2 5 , Ulrich Meinzer 1 2 24 25 , Caroline Galeotti 3 , Isabelle Melki 26 22 27
Affiliations
- PMID: 32527868
- DOI: 10.1136/annrheumdis-2020-217960
Abstract
Background: Current data suggest that COVID-19 is less frequent in children, with a milder course. However, over the past weeks, an increase in the number of children presenting to hospitals in the greater Paris region with a phenotype resembling Kawasaki disease (KD) has led to an alert by the French national health authorities.
Methods: Multicentre compilation of patients with KD in Paris region since April 2020, associated with the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ('Kawa-COVID-19'). A historical cohort of 'classical' KD served as a comparator.
Results: Sixteen patients were included (sex ratio=1, median age 10 years IQR (4?7 to 12.5)). SARS-CoV-2 was detected in 11 cases (69%), while a further five cases had documented recent contact with a quantitative PCR-positive individual (31%). Cardiac involvement included myocarditis in 44% (n=7). Factors prognostic for the development of severe disease (ie, requiring intensive care, n=7) were age over 5 years and ferritinaemia >1400 ?g/L. Only five patients (31%) were successfully treated with a single intravenous immunoglobulin (IVIg) infusion, while 10 patients (62%) required a second line of treatment. The Kawa-COVID-19 cohort differed from a comparator group of 'classical' KD by older age at onset 10 vs 2 years (p<0.0001), lower platelet count (188 vs 383 G/L (p<0.0001)), a higher rate of myocarditis 7/16 vs 3/220 (p=0.0001) and resistance to first IVIg treatment 10/16 vs 45/220 (p=0.004).
Conclusion: Kawa-COVID-19 likely represents a new systemic inflammatory syndrome temporally associated with SARS-CoV-2 infection in children. Further prospective international studies are necessary to confirm these findings and better understand the pathophysiology of Kawa-COVID-19. Trial registration number NCT02377245.
Keywords: cytokines; inflammation; outcome and process assessment, health care.