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. 2025 Sep 29;51(1):273.
doi: 10.1186/s13052-025-02120-6.

Clinical characteristics and outcomes of Kawasaki disease and multisystem inflammatory syndrome in Arab children during the COVID-19 pandemic: a single-center experience from the middle East

Yasser Sedky  1   2 , Selmen Wannes  3   4 , Sara Ali Saleh  5   6 , Shimaa Abdalaleem Abd Algaleel  7 , Yomna Farag  5   6 , Eman Toraih  8 , Hani Aiash  9 , Gehad Mohamed Gamal  3   10
Affiliations

Clinical characteristics and outcomes of Kawasaki disease and multisystem inflammatory syndrome in Arab children during the COVID-19 pandemic: a single-center experience from the middle East

Yasser Sedky et al. Ital J Pediatr. .

Abstract

Background: The emergence of Multisystem Inflammatory Syndrome in Children (MIS-C) during the COVID-19 pandemic has posed new challenges in differentiating it from classical Kawasaki disease (KD). Understanding their distinct presentations and outcomes is crucial for appropriate management strategies. We aimed to characterize and compare the clinical presentations, laboratory findings, cardiac manifestations, and treatment outcomes of KD and MIS-C in pediatric patients during the COVID-19 pandemic at a tertiary care center in Saudi Arabia.

Methods: In this retrospective cohort study, we analyzed data from 41 pediatric patients (ages 0-14 years) diagnosed with either KD (n = 31) or MIS-C (n = 10) between January 2020 and December 2023. Diagnoses were established using the American Heart Association criteria for KD and World Health Organization criteria for MIS-C. Clinical features, laboratory parameters, cardiac findings, and treatment responses were compared between groups.

Results: Among the 41 patients (median age 5.6 years, 56.1% male), KD patients demonstrated significantly higher rates of conjunctivitis (64.5% vs. 0%, p < 0.001) and rash (80.6% vs. 40%, p = 0.014) compared to MIS-C patients. Laboratory findings showed distinct patterns: KD patients had higher ESR (92.9 ± 50.7 vs. 58.4 ± 28.6 mm/hr, p = 0.042) and albumin levels (3.4 ± 0.4 vs. 3.1 ± 0.3 g/dL, p = 0.026), while MIS-C patients exhibited higher ferritin (1907 ± 3602 vs. 239 ± 397 ng/mL, p = 0.05), AST (398 ± 554.7 vs. 39.03 ± 23.8 U/L, p = 0.013), and LDH levels (973 ± 991.1 vs. 297.0 ± 96.6 U/L, p = 0.006). Coronary artery abnormalities were more frequent in KD (35.5% vs. 10% for diameter > 2 mm), with one case developing a coronary aneurysm. One mortality occurred in the MIS-C group due to sepsis.

Conclusions: This study identifies distinct clinical and laboratory profiles between KD and MIS-C during the COVID-19 pandemic. While both conditions can affect the coronary arteries, our findings suggest potentially different pathophysiological mechanisms. These observations may help inform diagnostic approaches and treatment strategies, though larger multicenter studies are needed to validate these findings.

Keywords: COVID-19; Coronary artery abnormalities; Kawasaki disease; Multisystem inflammatory syndrome in children; Pediatric vasculitis; SARS-CoV-2.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Written informed consent was obtained from all participants’ parents or legal guardians. The research protocol was conducted in accordance with the Declaration of Helsinki. Consent for publication: All authors approved the final version for publication and consent is available upon request to the corresponding author. Competing interests: Not applicable.

Figures

Fig. 1
Fig. 1
Coronary artery aneurysm in a patient with Kawasaki Disease. (A) Two-dimensional echocardiogram at initial presentation showing coronary artery aneurysm with maximal diameter of 5.0 mm. (B) Follow-up echocardiogram demonstrating partial regression of the aneurysm with reduction in maximal diameter to 4.0 mm. Images were obtained using standard parasternal short-axis view. Scale bars represent 1 mm
See this image and copyright information in PMC

References

    1. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Shulman ST, Bolger AF, Ferrieri P, Baltimore RS, Wilson WR, Baddour LM, Levison ME, Pallasch TJ, Falace DA, Taubert KA. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the committee on rheumatic fever, endocarditis and Kawasaki disease, Council on cardiovascular disease in the young, American heart association. Circulation. 2004;110:2747–71. 10.1161/01.CIR.0000145143.19711.78. - PubMed
    1. TullohRMR M-WR. Kawasaki disease: a prospective population survey in the UK and Ireland from 2013 to 2015. Arch Dis Child. 2018. 10.1136/archdischild-2018-315087. [Epub ahead of print].
    1. Terai M, Shulman ST. Prevalence of coronary artery Ab normalities in Kawasaki disease is highly dependent on gamma Globulin dose but independent of salicylate dose. J Pediatr. 1997;131:888–93. - PubMed
    1. Chen S, Dong Y, Yin Y, Krucoff MW. Intravenous Immuno Globulin plus corticosteroid to prevent coronary artery abnormalities in Kawasaki disease: a meta-analysis. Heart. 2013;99:76–82. - PubMed
    1. Hirono K, Kemmotsu Y, Wittkowski H, Foell D, Saito K, Ibuki K, Watanabe K, Watanabe S, Uese K, Kanegane H, Origasa H, Ichida F, Roth J, Miyawaki T, Saji T. Infliximab reduces the cytokine-mediated inflammation but does not suppress cellular infiltration of the vessel wall in refractory Kawasaki disease. Pediatr Res. 2009;65:696–701. 10.1203/PDR - PubMed

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