PMC:7373848 / 28394-30363 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7373848","sourcedb":"PMC","sourceid":"7373848","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7373848","text":"Kawasaki-like disease\nKawasaki Disease (KD) follows an excess innate immune response to viral pathogens. Several investigators have proposed involvement of the stimulator of interferon genes (STING) pathway inhibited upstream by aspirin and intravenous immunoglobulins [76]. The same mechanism may operate in COVID-19 where SARS–COV-2 binding to ACE2 increases STING pathway activation. In most instances, activation occurs during the second phase of illness with immune hyper-responses, decreased lymphocyte counts, increased monocyte populations that secrete cytotoxic cytokines and heightened B and T cell responses as well [77].\nKawasaki-like disease with accompanying toxic shock syndrome or multi-systemic inflammatory disease has been reported in children with COVID-19 [78, 79]-moderate coronary dilations were present in 25% of patients (age range 3–17 years). Myocarditis is also seen [80]. Cardiac MRI showed diffuse myocardial edema on T2-STIR sequences and Native-T1 mapping, with no evidence of late gadolinium enhancement [81].\nThe pediatric inflammatory multisystem syndrome (PIMS) and KD-like disease described in COVID-19 shares similarities with traditional KD, but there are several differences. PIMS occurs in older children (age 9 years or greater), children of African American, Caribbean, European and Hispanic ancestry rather than Asian ancestry. Gastrointestinal symptoms and a lack of mucocutaneous and lymphatic signs are also differentiating factors. Myocarditis is a distinguishing feature of PIMS as well at times requiring mechanical circulatory support [82].\nAdult-onset Kawasaki Disease Shock Syndrome complicated by coronary aneurysms occurred in a 20-year-old man of East Asian ancestry [83]. He received corticosteroids and intravenous immunoglobulin. Securing a diagnosis is critical as early treatment (≤ 4 days) reduces the development of coronary arterial aneurysms and with shock syndrome improves left ventricular 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