SARS-CoV-2-Induced Kawasaki-Like Hyperinflammatory Syndrome: A Novel COVID Phenotype in Children
SARS-CoV-2-Induced Kawasaki-Like Hyperinflammatory Syndrome: A Novel COVID Phenotype in Children
复制标题
DOI：
10.1542/peds.2020-1711
复制
发表时间：
2020-08-01
期刊：
影响因子：
8
通讯作者：
Montin, Davide
中科院分区：
文献类型：
--
作者：
Licciardi, Francesco;Pruccoli, Giulia;Montin, Davide
在我们的文章中，我们描述了两名患有川崎样高炎症综合征的前两例儿童，他们的 SARS-CoV-2 病毒 IgG 滴度较高。我们描述了 2 名持续发烧和严重腹泻的儿童，他们出现了皮肤粘膜受累的迹象（结膜炎、嘴唇干裂、皮疹、红斑和手脚水肿）。血液检查显示炎症、淋巴细胞减少、血小板减少和补体消耗的标志物升高。随后，在毛细血管渗漏综合征的背景下出现弥漫性水肿伴低蛋白血症。两名患者的重复鼻拭子检测结果显示，严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 呈阴性，但每位患者的 SARS-CoV-2 病毒免疫球蛋白 G 和免疫球蛋白 M 滴度均较高。在存在免疫球蛋白 M 和免疫球蛋白 G 的情况下，PCR 结果呈阴性，表明炎症反应是在病毒感染的后期发生的，当时在上呼吸道中检测不到 SARS-CoV-2。在本报告中，我们描述了患有 SARS-CoV-2 诱发的川崎样高炎症综合征的患者。 SARS-CoV-2 诱发的川崎样高炎症综合征似乎是由对 SARS-CoV-2 的延迟反应引起的。它类似于川崎病并发巨噬细胞激活综合征，但具有前驱腹泻、毛细血管渗漏综合征和心肌功能障碍等独特特征。静脉注射皮质类固醇治疗似乎有帮助。
In our article, we describe the first two cases of Kawasaki-like hyperinflammatory syndrome in two children with high titers of IgG against the SARS-CoV-2 virus. We describe 2 children with persistent fever and profuse diarrhea who developed signs of mucocutaneous involvement (conjunctivitis, fissured lips, skin rash, erythema, and edema of the hands and feet). Blood tests revealed elevated markers of inflammation, lymphopenia, thrombocytopenia, and complement consumption. Afterward, diffuse edema with hypoalbuminemia appeared in the context of a capillary leak syndrome. In both patients, repeated nasal swabs were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but each patient had high titers of immunoglobulin G and immunoglobulin M against the SARS-CoV-2 virus. The negative PCR results in the presence of immunoglobulin M and immunoglobulin G suggested that the inflammatory response developed in the late phase of viral infection, when SARS-CoV-2 was not detectable in the upper airway. In this report, we describe patients with what we propose to name as SARS-CoV-2-induced Kawasaki-like hyperinflammatory syndrome. SARS-CoV-2-induced Kawasaki-like hyperinflammatory syndrome seems to be caused by a delayed response to SARS-CoV-2. It resembles Kawasaki disease complicated by macrophage activation syndrome, although it has peculiar features, such as prodromal diarrhea, capillary leak syndrome, and myocardial dysfunction. Intravenous corticosteroid treatment appears to be helpful.