Kawasaki-like syndrome associated with COVID-19 in an adult: AJO Case Report

Kawasaki- like syndrome associated with COVID-19 has been reported in pediatric patients and adolescents below 19 years of age. The WHO definition for this syndrome differs slightly from the classical criteria for Kawasaki disease in children.

World Health Organization (WHO) Preliminary Case Definition of COVID-19 Kawasaki Syndrome in Children and Adolescents criteria are:

1. Fever for more than 3 days

2. At least two of the following features

• Rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammatory signs (oral, hands, feet)

• Hypotension or shock

• Myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities

• Evidence of coagulopathy on laboratory testing

• Acute gastrointestinal problems (diarrhoea, vomiting, abdominal pain)

3. Laboratory criteria

• Elevated inflammatory makers on laboratory testing

• No other obvious microbial cause of inflammation

• Evidence of COVID-19 infection

The patient fulfilled the criteria for Kawasaki syndrome according to the old as well as the revised definition. He was treated with topical steroid and lubricating eye drops with topical steroid ointment. Systemically, IVIG and an IL-6 inhibitor (Tocilizumab) were administered. The patient responded well to therapy. The fever resolved with disappearance of the periorbital and perioral rash. Conjunctival hyperaemia, keratitis and AC reaction had also decreased significantly at 2 weeks.

COVID-19 is a new entity with novel presentations of the disease being reported every day. According to the authors, Kawasaki like syndrome associated with COVID-19 has not been previously reported in adults.

"Kawasaki-like syndrome reported in paediatric patients has serious and even life-threatening consequences. Clinicians should remain vigilant and alert about a similar possibility in adults," conclude the authors.

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https://www.journals.elsevier.com/american-journal-of-ophthalmology-case-reports/