Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Issue 8 (11th June 2020)

• Record Type: Journal Article
• Authors: Pouletty, Marie; Borocco, Charlotte; Ouldali, Naim; Caseris, Marion; Basmaci, Romain; Lachaume, Noémie; Bensaid, Philippe; Pichard, Samia; Kouider, Hanane; Morelle, Guillaume; Craiu, Irina; Pondarre, Corinne; Deho, Anna; Maroni, Arielle; Oualha, Mehdi; Amoura, Zahir; Haroche, Julien; Chommeloux, Juliette; Bajolle, Fanny; Beyler, Constance; Bonacorsi, Stéphane; Carcelain, Guislaine; Koné-Paut, Isabelle; Bader-Meunier, Brigitte; Faye, Albert; Meinzer, Ulrich; Galeotti, Caroline; Melki, Isabelle
• Is Part Of: Annals of the rheumatic diseases. Volume 79:Issue 8(2020)
• Page Start: 999
• Page End: 1006
• Publication Date: 2020-06-11
• Subjects: inflammation -- outcome and process assessment, health care -- cytokines; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2020-217960
• Languages: English
• ISSNs: 0003-4967

Abstract

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 12 cases (69%), while a further three cases had documented recent contact with a quantitative PCR-positive individual (19%). 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 µg/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