Kawasaki-like MIS-C Drives ICU Admissions in France

An assessment of 21 pediatric cases leads France investigators to believe development is due to post-viral immunological reactions.

During the recent coronavirus 2019 (COVID-19) outbreak, 21 children admitted to a Paris hospital were discovered to have Kawasaki-like Multisystem Inflammatory Syndrome, with the majority requiring intensive care treatment, according to new study findings.

A team of France-based investigators, led by Julie Toubiana, MD, associate professor at the University of Paris, reported that an unusually high number of these patients exhibited Kawasaki disease shock syndrome, gastrointestinal symptoms, and were of African descent. They published their findings in The BMJ.

“Our study documents an outbreak of Kawasaki-like multisystem inflammatory syndrome in children and adolescents in the Paris area and its association with recent SARS-CoV-2 infection,” the team wrote.

These pediatric patients ranging in ages from 3-16 years old were seen in the Necker Hospital for Sick Children in Paris between April 27 and May 11.

Seventeen (81%) patients were admitted to the intensive care unit (ICU) for management of hemodynamic instability. All presented with the criteria for Kawasaki disease on admission to the ICU.

Of the 21 patients, 10 received corticosteroids, and all of them received intravenous immunoglobin 2 g/kg. All patients have favorable outcomes and were discharged from the hospital by May 15.

Of the 21 patients, 12 had at least 1 parent originating from sub-Saharan Africa or a Caribbean island. All the patients exhibited gastrointestinal symptoms, and 12 presented with Kawasaki disease shock syndrome.

Investigators looked further into a connection between SARS-CoV-2 and the Kawasaki-like disease. France went into quarantine lockdown on March 17, and the parents of the pediatric patients were surveyed on their children’s social whereabouts. The parents reported that none of their children had traveled, gone to school, or went to any social gatherings during the lockdown.

Nine patients reported viral-like symptoms including: headache, cough, coryza, fever, and anosmia.

A history of recent contact with family members displaying viral-like symptoms was reported in 10 families. Symptoms in 5 of these family contacts were highly suspicious of COVID-19—ageusia, anosmia, suggestive findings on thoracic computed tomography. One contact had a positive RT-PCR test result for SARS-CoV-2.

The median interval between the reported contact and Kawasaki disease was 36 days (range, 18-45). The result of RT-PCR testing for SARS-CoV-2 was positive in 8 of the 21 patients presented. Only 1 patient exhibited symptoms of COVID-19, and another had anosmia before the onset of symptoms of Kawasaki disease.

“The temporal association between the onset of the COVID-19 pandemic in France and the results of tests (RT-PCR and IgG antibodies) for SARS-CoV-2 in our patients with Kawasaki-like disease suggests a causal link,” investigators concluded. “Furthermore, only one patient had symptoms suggestive of acute COVID-19 and most had positive serum test results for IgG antibodies, suggesting that the development of Kawasaki disease in these patients is more likely to be the result of a post-viral immunological reaction.”