This study shares the case of a 6 month infant simultaneously diagnosed with Kawasaki disease (KD) and COVID-19. The significance of the COVID-19 diagnosis parallel to the KD diagnosis is not clear; the paper simply shares symptoms and patient characteristics for future reference. Treatment for this case was routine and included intravenous immunoglobulin and high dose aspirin.
While COVID-19 has developed into a global pandemic with hundreds of thousands of deaths, its effect on the pediatric population appears significantly smaller than that on adults. While studying 1412 pediatric patients with suspected COVID-19, this research group found little information on the virus’s coincidence with other clinical conditions. This study serves as one of the first accounts of such a case, observing an infant diagnosed with KD and testing positive for COVID-19.
This specific case involved a full term, healthy, and vaccinated 6 month old infant brought in for fever, fusiness, and refusal to be fed. Her initial temperature was 38.8℃ and no cough, congestion, or rhinorrhea (mucus filled nasal cavity) was observed. Influenza swab and catheterized urinalysis were performed, bothing coming back negative. During her second day of fever, the infant developed an erythematous (red), non-pruritic (non-itchy) rash. Oxygen saturation was 100% and 200 beat/min sinus tachycardia was observed. Additional symptoms included irritability, conjunctivitis (with sclera around iris being white).
Lab tests indicated left shifted white blood cell count (immature neutrophils present) , normocytic anemia (low red blood cell count), elevated c-reactive protein (liver protein suggesting inflammation), and a high erythrocyte sedimentation rate (red blood cell test indicating inflammation or infection). The patient also had low sodium levels and low albumin levels. An echocardiogram showed no cardiac abnormalities.
Treatment included a single dose of intravenous immunoglobulin and a high dose of acetylsalicylic acid. COVID-19 diagnosis was confirmed by RT-PCR testing and the patient’s family was instructed to quarantine for two weeks.
Treatment for the KD was routine and the significance of the COVID-19 present at the same time remains unclear.
The infant did not exhibit respiratory problems which are often used as a constraint to authorize testing in areas where it is limited. This study suggests that pediatric patients exhibiting only fever may be missed (not tested for COVID-19) due to the lack of respiratory symptoms. With the inconclusive impact of COVID-19 and unknown origin of KD, this paper is more a reference for future cases than groundbreaking discovery.