Sakina S, Owais SS, Khan EA, Sheikh AM. vascular disease that affects mostly small and medium-sized blood vessels. It mostly occurs in children under five years of age of different ethnicities all around the world.1 Diagnostic criterion as outlined by American Heart Association in 2017, includes fever for five or more days, lips and oral mucosal changes, bilateral non-purulent conjunctival injection, polymorphous rash, peripheral extremity changes with subsequent desquamation of fingertips, and cervical lymphadenopathy of more than 1.5 cm in size.2 The aetiology of Kawasaki disease is still unknown but is thought to be related to combined effects of the immune response, genetic susceptibility, and infections.3 Viral respiratory infections, including SAR-CoV-2 (COVID-19), have been suggested as triggers for Kawasaki disease. It has been observed that in the context of SARS-CoV-2 blood circulation a greater proportion of patients with Kawasaki disease might present a severe phenotype with cardiac complications.4 In a study conducted at Shifa International Hospital Pakistan complete KD was present in 72% of the studied cohort of children with Kawasaki disease. Coronary artery abnormalities were present in one-third of these Licogliflozin children at a more youthful age and more common in those with incomplete KD but experienced recovered in most.5 Here we present a case of a seven-month-old male infant with Kawasaki Disease and a concurrent diagnosis of COVID-19 infection. CASE Statement A seven-month-old male infant presented in our outpatient department with an acute history of high-grade fever, documented up to 102F along with rash for one day. On physical examination, the patient was irritable, with non pruritic non-blanchable generalised maculopapular rash, non-exudative conjunctivitis, swollen lips, ulcers in the mouth, enlarged hyperaemic tonsils, and strawberry tongue (Fig.1). There was hepatomegaly, firm non-tender up to 5cm but no lymphadenopathy. The patient was admitted to our Paediatric ward for further workup and management with a differential diagnosis of Staphylococcal scalded skin syndrome, Scarlet fever and Kawasaki disease. The patient was started on broad-spectrum antibiotics along with other supportive management and relevant workup Licogliflozin was started. Open in a separate windows Fig.1 Rash in the resolving phase and cracked lips. Initial laboratory investigations showed, Hemoglobin (Hb) 10g/dl, leucocyte count (WBC) 13×109/L with predominant neutrophils (72%) and normal platelet (PLT) count 281×109/L. Quantitative C-reactive protein (CRP) was 144mg/dl, erythrocyte sedimentation rate (ESR) was 54mm/hr, Antistreptolysin O (ASO) titre was normal (<200), and urine routine showed 10-12 pus cells. COVID-19 Rapid antigen test was negative but the COVID antibody (IgM) was positive. Chest X-ray was normal. Other workup including coagulation profile, liver function assessments, renal function assessments, serum electrolytes and MP was unremarkable. In the subsequent week, patient experienced prolonged fever spikes Licogliflozin along with the development of bilateral non-pitting pedal oedema. The repeat complete blood count (CBC) showed moderate anaemia Hb 9.6g/dl, raised leukocyte count 27.5x109/L and thrombocytosis with platelet count of 504x109/L. Quantitative CRP and ESR were persistently high 135mg/dl and 82mm/hr respectively. The multisystem inflammatory syndrome in children (MIS-C) markers, serum ferritin 205ng/ml, LDH 321U/L and D-dimer 1061ng/ml were normal. Cardiac enzymes (Trop T <3pg/ml and ProBNP 257pg/ml) and ANA were negative. Throat swab culture grew streptococcus specie. The blood and urine cultures were unfavorable. Ultrasound abdomen showed gall bladder wall oedema with normal liver echotexture. Diagnosis of total Kawasaki disease was finalised. Echocardiography was carried out that showed dilated left and right coronary Mouse monoclonal to Human Albumin arteries with good biventricular function. No clot, thrombus or pericardial effusion (Fig.2). The patient was initially treated with Intravenous methylprednisolone for three days (due to financial constraints), followed by Intravenous Immunoglobulins (IVIG) 2g/kg. Aspirin was also started. Open in a separate windows Fig.2 Dilated left coronary artery and right artery with no clot thrombus and good biventricular function. Symptoms improved after steroid administration with total resolution of fever after IVIG. Later periungual skin peeling was also observed. Patient was discharged on oral steroids and low dose Aspirin. The patient was advised to avoid live vaccines and called for a follow-up. Follow up visit after one week showed marked improvement.