What is the mechanism underlying Kawasaki syndrome in the
context of COVID-19?
The mechanisms underlying Kawasaki disease -a generalized vasculitis, in
young children, of unknown, potentially post-viral etiology- are poorly
understood. The rare COVID-19-associated inflammatory syndrome also
features vasculitic changes, affects older children too and is often
only associated with positive SARS-CoV-2 serology, but not viral
shedding. Its mechanisms need to be elucidated and may include
post-infectious, antibody and immune-complex mediated pathology. In
adults, there are occasional cases of COVID-19-associated cutaneous
vasculitis, possibly a localized manifestation of the disease that leads
to severe generalized vasculitis in some
children.89-91 Interestingly Kawasaki-like disease was
not reported in Chinese cases and the first months of European cases.
The season of the disease and environmental factors should be
considered. The Chinese epidemic was mainly from January to March
whereas the USA epidemic started in mid-March and is still ongoing.