Response to 'COVID-19-associated multisystem inflammatory syndrome in adults with Kawasaki disease-like cutaneous manifestations'.

Dear Editor, The article by Razmi T et al. was read with great interest regarding Kawasaki disease (KD)‐like cutaneous features in multisystem inflammatory syndrome in adults (MIS‐A). KD‐like cutaneous features have been reported more from the paediatric age group, and data from adults are limited. The article raises some questions to be elucidated and some additional information to be appended.

Firstly, the authors have not clarified the type and site of rash or the duration of fever in the patient, which would be salient for association with both KD and MIS‐A. Moreover, it would have been more precise to label KD as complete or incomplete in the presence or absence of diagnostic features. The patient appeared to have incomplete KD as per the clinical features described by the authors.

Secondly, eosinophilia in the patient is mostly associated with the acute stage of KD or is associated with adverse drug reactions, but it is noteworthy that in COVID‐19, either normal peripheral eosinophil count or eosinopenia have been reported. The interval between severe SARS‐CoV2 infection and development of MIS‐A is unclear, and therefore early detection of either incomplete or complete KD‐like cutaneous features in the absence of substantial support from laboratory investigations may be helpful in the early diagnosis and treatment of MIS.

Information on MIS in either adults or children with overlapping features like KD or SARS‐CoV‐2 triggering KD is not complete. Cheung et al. described patterns of cytokines such as increased production of interleukin‐6 and interleukin‐10 in patients with MIS (children) and suggested that MIS is similar to KD. The presence of COVID‐19 IgM antibodies in the patient suggests that the patient must have had SARS‐CoV‐2 infection in the previous 2–3 weeks. KD‐like desquamation of the skin of the palms and soles and strawberry tongue may be seen in the convalescent stage of severe diseases or drug reaction, but an acute rise of inflammatory markers and multiorgan involvement may differentiate these from MIS. Therefore, it is pertinent to monitor any rash developing even after the crucial 14 days of COVID‐19 to curtail the morbidity or even mortality due to MIS.

Author Contribution

Yashdeep Singh Pathania: Conceptualization (lead); Data curation (lead); Writing‐original draft (lead); Writing‐review & editing (lead).