It was an interesting and informative read to go through the IAP position paper on Kawasaki disease (KD) published recently [1]. It was indeed necessary to have a nation-wide consensus, which is suitable for India where the distribution of health resources is unequal and constrained. KD has become one of the leading causes of acquired heart disease in many developed countries of the world [1]. With almost a year of coronavirus disease 19 (COVID-19) pandemic, a new hyper-inflammatory syndrome affecting children has been observed, and variously labeled as Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 or Pediatric inflammatory multi-system syndrome-temporally associated with SARS-CoV-2 (PIMS-TS) [2,3]. This condition has clinical features which overlap with other inflammatory diseases in childhood like Kawasaki disease (KD) and toxic shock syndrome (TSS) [2].

The position paper [1] mentions various differential diagnosis of KD, but does not mention PIMS-TS or MIS-C. It is important that this entity should be considered in the differential diagnosis of KD, as the clinical presentation is very much overlapping, though the underlying mechanism for hyper-inflammation is different. In KD inflammation of the coronary arteries is due to IL-1, the myocardial dysfunction and higher severity of the 2019-nCoV infection is predominantly driven by IL-6 and IL-10 in MIS-C [4]. Three different phenotypes of hyperinflammation in children has been speculated as classic KD, PIMS-TS and macrophage activation syndrome [4]. Though IVIG and steroids are the mainstay of therapy in these conditions and aspirin also important in KD, the prognosis and long term follow up are different. Hence the authors would like to suggest that this evolving inflammatory disease should be included in the position paper as one of the differentials for KD.

1. Shenoy B, Singh S, Ahmed MZ, Pal P, Balan S, Vishwanthan V. Indian Academy of Pediatrics Position Paper on Kawasaki Disease. Indian Pediatr. 2020;57: 1040-48.

2. Royal College of Pediatrics and Child Health. Guidance–Pediatric multisystem inflammatory syndrome temporally associated with COVID-19, 2020. Accessed December 02, 2020. Available from: https://www.rcpch.ac.uk/resources/guidance-pediatric-multi system-inflammatory-syndrome-temporally-associated covid-19

3. Bhat CS, Gupta L, Balasubramanians, Singh S, Ramanan AV. Hyperinflammatory syndrome in children associate with COVID-19: Need for awareness. Indian Pediatr. 2020;57:929-35.

4. Shulman ST. Pediatric coronavirus disease-2019-associated multisystem inflammatory syndrome. J Pediatric Infect Dis. 2020;9:285-6.