Inclusion of Multisystem Inflammatory Syndrome in Children and Adolescents Temporally Related to COVID -19 in the Differential Diagnosis of Kawasaki Disease: Authors' Reply

Correspondence

Indian Pediatr 2021;58: 191-192

	Inclusion of Multisystem Inflammatory Syndrome in Children and Adolescents Temporally Related to COVID -19 in the Differential Diagnosis of Kawasaki Disease: Authors' Reply
Bhaskar Shenoy Department of Pediatrics, Manipal Hospitals, Bangalore, Karnataka, India. [email protected]
We thank the authors for raising this pertinent point. We are in total agreement that MISC (PIMS) is one of the differential diagnoses of Kawasaki disease. The draft of this article; however, was prepared prior to the onset of COVID-19 pandemic, and thus it was missed out in the list of differential diagnosis of KD in the consensus statement. The committee has modified the differential diagnosis as follows: Differential Diagnosis of Kawasaki Disease 1. Infections – Bacterial (streptococcal, leptospirosis, rickettsia), Viral (measles, adenovirus, Epstein Barr virus). 2. Toxin related – Staphylococcal scalded skin syndrome, toxic epidermal necrolysis 3. Inflammatory – Systemic juvenile idiopathic arthritis 4. Drug hypersensitivity – Steven-Johnson syndrome, drug reaction with eosinophilia and systemic symptoms (DRESS), mercury hypersensitivity. 5. Multisystem inflammatory disease of childhood temporally related to COVID-19 (MISC-C): A condition recognized and described during the COVID-19 pandemic. This occurs largely in children, usually above 5 years of age, as a short term illness with high grade fever and often with shock with multisystem inflammation. One of the phenotypes can resemble incomplete Kawasaki disease. This is considered to be secondary to immune dysregulation triggered after or in the later phase of the infection by severe acute respiratory syndrome coronavirus (SARS-CoV-2).