We describe two 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 for SARS-CoV-2 were negative but each had high titers of IgG and IgM against the SARS-CoV-2 virus. The negative PCR in the presence of IgM and IgG suggest that the inflammatory response developed in the late phase of viral infection when SARS-CoV-2 was not detectable in the upper airway.
This report describes patients with what we propose to name as SARS-CoV-2-induced Kawasaki- like Hyperinflammatory Syndrome (SCiKH Syndrome). SCiKH 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.
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