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SARS-CoV-2–Related Inflammatory Multisystem Syndrome in ChildrenDifferent or Shared Etiology and Pathophysiology as Kawasaki Disease?

Educational Objective
To understand the similarities between the inflammatory multisystem syndrome and Kawasaki disease
1 Credit CME

The pediatric inflammatory multisystem syndrome (PIMS) now described in association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has generated considerable interest, both for its severity and delayed emergence in an age group largely spared the complications of primary infection, but also for its overlapping clinical features with Kawasaki disease (KD), the leading cause of acquired heart disease in children in high-income countries.1 This has prompted considerable discussion that the 2 conditions could have different or shared etiologic and pathophysiologic pathways.

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Article Information

Corresponding Author: Brian W. McCrindle, MD, MPH, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, 555 University Ave, Toronto, ON M5G 1X8, Canada (brian.mccrindle@sickkids.ca).

Published Online: June 8, 2020. doi:10.1001/jama.2020.10370

Conflict of Interest Disclosures: Dr McCrindle reported receiving personal fees from Janssen and serving as an investigator for Janssen and Mezzion. No other disclosures were reported.

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Whittaker  E , Bamford  A , Kenny  J ,  et al; PIMS-TS Study Group; EUCLIDS and PERFORM Consortia.  Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2.   JAMA. Published online June 8, 2020. doi:10.1001/jama.2020.10369Google Scholar
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Uehara  R , Yashiro  M , Nakamura  Y , Yanagawa  H .  Kawasaki disease in parents and children.   Acta Paediatr. 2003;92(6):694-697. doi:10.1111/j.1651-2227.2003.tb00602.x PubMedGoogle ScholarCrossref
Onouchi  Y , Gunji  T , Burns  JC ,  et al.  ITPKC functional polymorphism associated with Kawasaki disease susceptibility and formation of coronary artery aneurysms.   Nat Genet. 2008;40(1):35-42. doi:10.1038/ng.2007.59 PubMedGoogle ScholarCrossref
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Burns  JC , Herzog  L , Fabri  O ,  et al; Kawasaki Disease Global Climate Consortium.  Seasonality of Kawasaki disease: a global perspective.   PLoS One. 2013;8(9):e74529. doi:10.1371/journal.pone.0074529 PubMedGoogle Scholar
Hearn  J , McCrindle  BW , Mueller  B ,  et al.  Spatiotemporal clustering of cases of Kawasaki disease and associated coronary artery aneurysms in Canada.   Sci Rep. 2018;8(1):17682. doi:10.1038/s41598-018-35848-9 PubMedGoogle ScholarCrossref
Nagao  Y , Urabe  C , Nakamura  H , Hatano  N .  Predicting the characteristics of the aetiological agent for Kawasaki disease from other paediatric infectious diseases in Japan.   Epidemiol Infect. 2016;144(3):478-492. doi:10.1017/S0950268815001223 PubMedGoogle ScholarCrossref
Awaya  A , Sahashi  N .  The etiology of Kawasaki disease: does intense release of pollen induce pollinosis in constitutionally allergic adults, while constitutionally allergic infants develop Kawasaki disease?   Biomed Pharmacother. 2004;58(2):136-140. doi:10.1016/j.biopha.2003.08.026 PubMedGoogle ScholarCrossref
Zeft  AS , Burns  JC , Yeung  RS ,  et al.  Kawasaki disease and exposure to fine particulate air pollution.   J Pediatr. 2016;177:179-183.e1. doi:10.1016/j.jpeds.2016.06.061PubMedGoogle ScholarCrossref
Fujiwara  T , Shobugawa  Y , Matsumoto  K , Kawachi  I .  Association of early social environment with the onset of pediatric Kawasaki disease.   Ann Epidemiol. 2019;29:74-80. doi:10.1016/j.annepidem.2018.10.010 PubMedGoogle ScholarCrossref
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Shirato  K , Imada  Y , Kawase  M , Nakagaki  K , Matsuyama  S , Taguchi  F .  Possible involvement of infection with human coronavirus 229E, but not NL63, in Kawasaki disease.   J Med Virol. 2014;86(12):2146-2153. doi:10.1002/jmv.23950 PubMedGoogle ScholarCrossref
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Rowley  AH , Baker  SC , Arrollo  D ,  et al.  A protein epitope targeted by the antibody response to Kawasaki disease.   J Infect Dis. Published online February 13, 2020. doi:10.1093/infdis/jiaa066 PubMedGoogle Scholar
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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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