Characteristics of Kawasaki disease in children with a history of COVID-19.

Objective: To investigate the characteristics of Kawasaki disease (KD) patients with a history of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, including asymptomatic cases.

Methods: This retrospective study included 63 patients in whom KD was diagnosed between April 2021 and March 2024. We compared demographic and clinical characteristics of patients with KD who did and did not have a history of COVID-19 (KD-COVID-19 vs. KD-non-COVID-19). We also compared these characteristics in the patients who tested positive for the anti-SARS-CoV-2 spike protein antibody in the two groups (antibody-positive KD-COVID-19 vs. antibody-positive KD-non-COVID-19).

Results: Of the 63 patients with KD, 13 had a history of COVID-19. Resistance to initial intravenous immunoglobulin therapy was higher among patients who had had COVID-19 (62%) than among those without COVID-19 (24%; P = 0.017), as were median serum B-type natriuretic peptide (BNP) levels (59.1 vs. 16.0 pg/mL, respectively; P = 0.017). Eight patients (62%) who had had COVID-19 and 16 (32%) who had not had COVID-19 tested positive for the anti-SARS-CoV-2 spike protein antibody. Among patients who were antibody-positive, median serum BNP levels were significantly higher in the patients who had had COVID-19 (76.6 pg/mL) than in those who had not had COVID-19 (14.5 pg/mL; P < 0.001).

Conclusion: Patients with KD who had a history of symptomatic SARS-CoV-2 infection are prone to elevated serum BNP levels, which may indicate potential ventricular dysfunction.