According to several studies, children represent only about 2% of the patients affected by the current SARS-CoV-2, and most often, they are asymptomatic. However, there is a concern about a vascular inflammatory disease which is similar to Kawasaki disease observed in children and adolescents weeks after infection. We report a case of Kawasaki disease presented with ischemic stroke in a 14-year-old male patient following SARS-Cov-2 infection.
Case report
A 14-year-old male with classical signs of Kawasaki Disease (KD) and no chronic medical condition presented with ischemic stroke. The diagnosis was challenging because the prior COVID-19 was silent and the skin rashes were very prominent on admission. Therefore, the patient was admitted and empirically treated in the clinic of dermatology at first days, and only after complicated with neurological symptoms, he was transferred to the Neurology Clinic. Prior infection with SARS-CoV-2 was confirmed based on serological testing and prior contact with the infected family member. Brain ischemia was confirmed with MRI. Even though there was not any large artery or venous occlusion apparent on CTA, increased pulsatility index was found on the left MCA suggesting distal small diameter arterial segments occlusion. After treatment with IVIG, corticosteroids, and low-dose aspirin, the neurological deficit was resolved. The exact pathomechanism of the Multisystem Inflammatory Syndrome in Children (MIS-C) is not clear. Given the lag between SARS-CoV-2 infection and MIS-C and the finding that many patients are positive for antibodies and negative for the viral antigen, it has been suggested that abnormal immune response might be the key factor. A potential role of the antibodies in the pathogenesis of KD has been accepted, and the prevalence of such antibodies to target different tissues in the body could explain the multisystem presentation in MIS-C [10].
Conclusion
There is a myriad of COVID-19 symptoms and sequelae making the diagnosis challenging. Early diagnosis and prompt treatment of the secondary inflammatory syndromes, including Kawasaki disease, is very important for preventing end-organ damage and long-term complications
