2During the Coronavirus disease 2019 (COVID-19) pandemic, children are less affected than adults, and underlying conditions and older age are associated with severe disease. Following the SARS-CoV-2 pandemic, outbreaks of cases with Kawasaki-like disease and a few others with the multisystem inflammatory syndrome in children related to COVID-19 (MIS-C) have been reported. Here, we report a two-year-old girl initially admitted to urgent pediatric care and was diagnosed with Kawasaki disease associated with COVID-19 infection to highlight the clinical features and signs. Physical examination showed a fussy infant with swelling of the hands, feet, and lips, red lips, restlessness, anorexia, and fever. According to the clinical and laboratory findings, Kawasaki disease was diagnosed. Laboratory tests for SARS-CoV-2 were positive. The patient's clinical symptoms improved after receiving medications such as IVIG and ascorbic acetyl acid.

Kawasaki disease is a systemic vasculitis that mainly affects younger children. Although the definite cause still remains unknown but the clinical and epidemiologic findings discuss an infectious cause. The prevalence of incomplete Kawasaki disease reported 15 to 36.2%, and it is more frequent in the extremes of the age spectrum. Non delayed treatment of disease should be initiated because of critical cardiac vascular complications. Up to 15%-25% of patients with Kawasaki disease who remain febrile after administration of first dose of intravenous immunoglobin plus aspirin are classified as refractory disease. These intravenous immunoglobin resistant cases are at increasing risk for coronary artery complications. The strategy on prediction of potentially non responder and treatment of intravenous immunoglobin resistant patients is now controversial but some useful points were recommended.

Kawasaki disease is believed to be the commonest vasculitis of medium vessels in Asian children. However, the majority of children with Kawasaki disease continue to remain undiagnosed perhaps because of the lack of awareness amongst pediatricians. The clinical features of Kawasaki disease can be confused with other common conditions such as Scarlet fever, Stevens Johnson syndrome, Measles fever, systemic onset JIA, etc. Development of coronary artery abnormalities is the hallmark of Kawasaki disease and accounts for most morbidity and mortality associated with the disease. Quick recognition of the disease and early treatment with intravenous immunoglobulin results in a significant decrease in the occurrence of coronary artery abnormalities.This review emphasizes that Kawasaki disease should be considered in differential diagnosis of all febrile illnesses in young children.

Introduction: Pyuria is included in the American Heart Association list of supporting laboratory data for diagnosis of Kawasaki disease (KD). The aim of this study was to define the rate of pyuria in children with KD and investigate the relation with other clinical and laboratory findings.Methods: In a prospective study, we evaluated all cases of Kawasaki disease referred to our center during 2002 to 2010 according to AAP definition. All patients were treated at Imam-Reza hospital (a university hospital with 995 beds) in Mashhad (a city in northeastern of Iran). Pyuria was defined as. 10 WBCs /HPF in the urine.Results: Pyuria was present in 42 (40.8%) of 103 children with KD. Children with KD and pyuria had more vomiting (P = 0.036), higher PMN in blood profile (P = 0.034) and elevated ALT (P = 0.034) in relation to children with KD without pyuria. The presence of pyuria was associated with less cardiac involvement in these patients but statistically insignificant (P = 0.057).Conclusion: Pyuria is common in children with KD. There was not any increased risk of cardiac involvement in children with KD and pyuria.