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J Pediatr Infect Dis 2023; 18(02): 107-112
DOI: 10.1055/s-0042-1758055
Case Report

A Case of Adult-Onset Kawasaki Disease in an Adolescent Occurring during the COVID-19 Pandemic

Christoph Aebi
1   Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
,
Nina Schöbi
1   Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
,
Andrea Duppenthaler
1   Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
,
Matthias V. Kopp
1   Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
3   Center North (ARCN), Member of the German Lung Research Center (DZL), University of Lübeck, Lübeck, Germany
,
Martin Glöckler
2   Division of Pediatric Cardiology, Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
,
Philipp K. A. Agyeman
1   Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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Abstract

We report the occurrence of the adult-onset type of Kawasaki disease (KD) with classic mucocutaneous manifestations of KD, cholestatic liver disease, multiple splenic infarcts, and residual multiple coronary artery dilatations in a previously healthy 14-year-old male adolescent 16 days after having received one dose of the BNT162b2 coronavirus disease 2019 (COVID-19) mRNA vaccine. First, the report serves to highlight the diagnostic challenges of adult-onset KD often resulting in therapeutic delay and the frequently reported occurrence of persistent cardiovascular sequelae. Second, the report emphasizes that the temporal association of KD with the administration of a COVID-19 vaccine will likely be a frequent constellation in the near future, raising questions of a causative association. While there is currently no evidence of such an association in persons above 5 years of age, large-scale vaccination of children below 5 years of age will require close surveillance of vaccine-related adverse events.

Keywords

adult-onset - Kawasaki disease - vaccine - SARS-CoV-2 - COVID-19

Ethics Statement

Bern University Hospital General Consent (GC) was granted by the patient and his parents for the use of routine clinical data in the medical record for research purposes. In addition, oral informed consent was obtained from the patient and his parents as required by the University Hospital for case reports. The Cantonal Ethics Committee, Bern, Switzerland, declared nonresponsibility.


Author Contributions

C. A., N. S., A. D., M. V. K., M. G., and P. K. A. A. cared for the patient. C. A., A. D., and P. K. A. A. drafted the manuscript. M. G. performed and evaluated the cardiac imaging studies. All authors contributed to the final version of the manuscript.




Publication History

Received: 01 July 2022

Accepted: 15 September 2022

Article published online:
23 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Burns JC, Glodé MP. Kawasaki syndrome. Lancet 2004; 364 (9433): 533-544
    CrossrefPubMedGoogle Scholar
  • 2 Peter E, Fraison JB, Harbaoui B. et al. Cardiovascular outcome in adult-onset Kawasaki disease. Autoimmun Rev 2021; 20 (09) 102886
    CrossrefPubMedGoogle Scholar
  • 3 Ward JL, Harwood R, Smith C. et al. Risk factors for PICU admission and death among children and young people hospitalized with COVID-19 and PIMS-TS in England during the first pandemic year. Nat Med 2022; 28 (01) 193-200
    CrossrefPubMedGoogle Scholar
  • 4 Vella LA, Rowley AH. Current insights into the pathophysiology of multisystem inflammatory syndrome in children. Curr Pediatr Rep 2021; 9 (04) 83-92
    CrossrefPubMedGoogle Scholar
  • 5 Abdelgalil AA, Saeedi FA. Multisystem inflammatory syndrome in a 12-year-old boy after mRNA-SARS-CoV-2 vaccination. Pediatr Infect Dis J 2022; 41 (03) e93-e94
    CrossrefPubMedGoogle Scholar
  • 6 Poussaint TY, LaRovere KL, Newburger JW. et al. Multisystem inflammatory-like syndrome in a child following COVID-19 mRNA vaccination. Vaccines (Basel) 2021; 10 (01) 43
    CrossrefPubMedGoogle Scholar
  • 7 Nune A, Iyengar KP, Goddard C, Ahmed AE. Multisystem inflammatory syndrome in an adult following the SARS-CoV-2 vaccine (MIS-V). BMJ Case Rep 2021; 14 (07) e243888
    CrossrefPubMedGoogle Scholar
  • 8 Zambrano LD, Newhams MM, Olson SM. et al; Overcoming COVID-19 Investigators. Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA vaccination against multisystem inflammatory syndrome in children among persons aged 12-18 years - United States, July-December 2021. MMWR Morb Mortal Wkly Rep 2022; 71 (02) 52-58
    CrossrefPubMedGoogle Scholar
  • 9 Levy M, Recher M, Hubert H. et al. Multisystem inflammatory syndrome in children by COVID-19 vaccination status of adolescents in France. JAMA 2022; 327 (03) 281-283
    CrossrefPubMedGoogle Scholar
  • 10 D'Angelo F, Varisco PA, So A, Taponnier M, Zufferey P. A 19-year-old woman with polyarthritis, anterior uveitis and coronary vasculitis: a case of adult Kawasaki disease. Joint Bone Spine 2015; 82 (06) 468-470
    CrossrefPubMedGoogle Scholar
  • 11 Bachmeyer C, Turc Y, Curan D, Duval-Arnould M. Anterior uveitis as the initial sign of adult Kawasaki syndrome (mucocutaneous lymph node syndrome). Am J Ophthalmol 2000; 129 (01) 101-102
    CrossrefPubMedGoogle Scholar
  • 12 Gallerani M, Pala M, Fabbian F, De Giorgi A. Acute cholestasis as uncommon onset of Kawasaki disease: a case report. BMC Gastroenterol 2020; 20 (01) 357
    CrossrefPubMedGoogle Scholar
  • 13 Granel B, Serratrice J, Ene N. et al. Painful jaundice revealing Kawasaki disease in a young man. J Gastroenterol Hepatol 2004; 19 (06) 713-715
    CrossrefPubMedGoogle Scholar
  • 14 Péter Z, Prinz G, Schuller J, Szalman K, Telegdy L. Adult-onset Kawasaki syndrome in the differential diagnosis of liver disease [in Hungarian]. Orv Hetil 2001; 142 (27) 1457-1458
    PubMedGoogle Scholar
  • 15 Peralta-Amaro AL, Tejada-Ruiz MI, Rivera-Alvarado KL. et al. Atypical Kawasaki disease after COVID-19 vaccination: a new form of adverse event following immunization. Vaccines (Basel) 2022; 10 (01) 126
    CrossrefPubMedGoogle Scholar
  • 16 Fraison JB, Sève P, Dauphin C. et al; CRI and the French Vasculitis Study Group. Kawasaki disease in adults: observations in France and literature review. Autoimmun Rev 2016; 15 (03) 242-249
    CrossrefPubMedGoogle Scholar
  • 17 Huong DL, Gatfosse M, Papo T, Barjonet G, Lacombe P, Godeau P. Symptomatic splenic infarction complicating adult Kawasaki disease. Br J Rheumatol 1995; 34 (06) 579-580
    CrossrefPubMedGoogle Scholar
  • 18 Bonté I, Mahr A, Laroche L, Guillevin L, Robineau M. Peripheral gangrene in adult-onset Kawasaki disease. Scand J Rheumatol 2005; 34 (01) 71-73
    CrossrefPubMedGoogle Scholar
  • 19 Brigger D, Horn MP, Pennington LF. et al. Accuracy of serological testing for SARS-CoV-2 antibodies: first results of a large mixed-method evaluation study. Allergy 2021; 76 (03) 853-865
    CrossrefPubMedGoogle Scholar
  • 20 Toh ZQ, Anderson J, Mazarakis N. et al. Comparison of seroconversion in children and adults with mild COVID-19. JAMA Netw Open 2022; 5 (03) e221313
    CrossrefPubMedGoogle Scholar
  • 21 Di Pietrantonj C, Rivetti A, Marchione P, Debalini MG, Demicheli V. Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev 2020; 4: CD004407
    PubMedGoogle Scholar
  • 22 Esposito S, Mariotti Zani E, Torelli L. et al. Childhood vaccinations and type 1 diabetes. Front Immunol 2021; 12: 667889
    CrossrefPubMedGoogle Scholar
  • 23 Olivieri B, Betterle C, Zanoni G. Vaccinations and autoimmune diseases. Vaccines (Basel) 2021; 9 (08) 815
    CrossrefPubMedGoogle Scholar
  • 24 Hua W, Izurieta HS, Slade B. et al. Kawasaki disease after vaccination: reports to the vaccine adverse event reporting system 1990-2007. Pediatr Infect Dis J 2009; 28 (11) 943-947
    CrossrefPubMedGoogle Scholar
  • 25 Huang WT, Juan YC, Liu CH, Yang YY, Chan KA. Intussusception and Kawasaki disease after rotavirus vaccination in Taiwanese infants. Vaccine 2020; 38 (40) 6299-6303
    CrossrefPubMedGoogle Scholar
  • 26 Mellone NG, Silva MT, Paglia MDG. et al. Kawasaki disease and the use of the rotavirus vaccine in children: a systematic review and meta-analysis. Front Pharmacol 2019; 10: 1075
    CrossrefPubMedGoogle Scholar
  • 27 Ae R, Shibata Y, Kosami K, Nakamura Y, Hamada H. Kawasaki disease and pediatric infectious diseases during the coronavirus disease 2019 pandemic. J Pediatr 2021; 239: 50-58.e2
    CrossrefPubMedGoogle Scholar
  • 28 Koskela U, Helve O, Sarvikivi E. et al. Multi-inflammatory syndrome and Kawasaki disease in children during the COVID-19 pandemic: a nationwide register-based study and time series analysis. Acta Paediatr 2021; 110 (11) 3063-3068
    CrossrefPubMedGoogle Scholar