Overlaping Syndromes: Kawasaki-Like Disease in Pediatric Multisystem Inflammatory Syndrome vs Atypical Kawasaki Disease. British or American? One Case, Many Possibilities

Erythema and cracked lips, strawberry tongue and/or erythema of the pharynx and oral mucosa

Bilateral bulbar conjunctival injection

Rash maculopapular, erythematous

Erythema and edema of the hands and feet in acute phase or periungual desquamation in subacute phase

Cervical lymph nodes ≥1.5 cm.

Children with

• • Prolonged Fever (≥5 days)

• • 2–3 criteria

OR

Infants with Prolonged Fever (≥7 days without other explanation)

Compatible laboratory tests (3 of the 6 criteria)

• ❍

  anemia

• ❍

  thrombocytosis after the 7^th day of fever

• ❍

  albumin level ≤3 g/dl

• ❍

  elevated ALT level

• ❍

  WBC≥15,000/mm³

• ❍

  Urine≥10WBC/hpf

Compatible echocardiographic findings (any of the following)

• ❍

  Z score LAD or RCA ≥2.5

• ❍

  Coronary artery aneurysm

• ❍

  ≥3 features from:

  • ▪

    Decreased LV function

  • ▪

    Pericardial effusion

  • ▪

    Z score LAD 2–2.5

  • ▪

    Mitral regurgitation

Child 0–19 years

Fever ≥3 days

Clinical signs of multisystem involvement (at least 2 of following):

• ❍

  rash/bilateral non-purulent conjunctivitis/mucocutaneous inflammation signs: oral, hands or feet

• ❍

  hypotension or shock

• ❍

  features of myocardial dysfunction, pericarditis, valvulitis, coronary abnormalities (echo findings or troponin/NT proBNP)

• ❍

  evidence of coagulopathy (prolonged prothrombin time, partial thromboplastin time or elevated D-dimers)

• ❍

  Acute gastrointestinal symptoms (diarrhea, vomiting, abdominal pain)

Elevated markers of inflammation such as C reactive protein, procalcitonin, erythrocyte sedimentation rate.

No other obvious microbial cause of inflammation, including bacterial sepsis, staphylococcal/streptococcal toxic shock syndrome

Evidence of COVID-19 (RT PCR, antigen test, serology) or likely contact with patients with COVID-19