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Multisystem inflammatory syndrome in children following severe acute respiratory syndrome coronavirus 2 infection is characterized by fever, elevated inflammatory markers, and multisystem organ involvement. Presentations are variable but often include gastrointestinal symptoms. We describe 5 children with fever and gastrointestinal symptoms initially concerning for multisystem inflammatory syndrome in children who were ultimately diagnosed with bacterial enteritis, highlighting the diagnostic challenges presented by the severe acute respiratory syndrome coronavirus 2 pandemic.

Background Accurate risk prediction of coronary artery aneurysms ( CAAs ) in North American children with Kawasaki disease remains a clinical challenge. We sought to determine the predictive utility of baseline coronary dimensions adjusted for body surface area ( z scores) for future CAAs in Kawasaki disease and explored the extent to which addition of established Japanese risk scores to baseline coronary artery z scores improved discrimination for CAA development. Methods and Results We explored the relationships of CAA with baseline z scores; with Kobayashi, Sano, Egami, and Harada risk scores; and with the combination of baseline z scores and risk scores. We defined CAA as a maximum z score (zMax) ≥2.5 of the left anterior descending or right coronary artery at 4 to 8 weeks of illness. Of 261 patients, 77 patients (29%) had a baseline zMax ≥2.0. CAAs occurred in 15 patients (6%). CAAs were strongly associated with baseline zMax ≥2.0 versus P Conclusions In a North American center, baseline zMax ≥2.0 in children with Kawasaki disease demonstrated high predictive utility for later development of CAA . Future studies should validate the utility of our findings.

Aim: At a single pediatric tertiary care center, we assessed the performance of established Japanese risk scores (RS) to identify patients (pts) with Kawasaki Disease (KD) at higher risk for re-treatment (re-tx). We also sought to determine if the addition of baseline coronary Z-scores to RS could improve the prediction re-tx. Methods: We reviewed available clinical, lab and echocardiogram (echo) data for KD pts treated from 1/2006 to 5/2014. The maximum z-score (zMax) of the right coronary artery (RCA) or left anterior descending artery (LAD) at baseline was used. Abnormal coronary arteries at baseline echo were defined as zMax ≥2 in the RCA or LAD. Kobayashi, Sano, Egami and Harada scores were calculated, comparing low and high risk scores to re-tx. The zMax was incorporated into each RS with 1 point added (+1) if baseline zMax ≥2. In an alternative approach, zMax was added as a covariate in a logistic regression model. The discrimination of each model was assessed using the c statistic. Results: Of 339 pts, 214 (63%) were male, and median age was 3.2 y (range 0.1-14.1 y). At diagnosis, 29% (97/339) had ≤3 classical criteria for KD, and 25% (85/339) received IVIG re-tx. At baseline, the median zMax was 1.37 (-1.64-14.2) and 26% (88/339) had zMax ≥2. Classification as high risk by all four RS was significantly associated with re-tx (p Conclusions: Published RS for predicting IVIG resistance are associated with higher rates of re-tx in our patient population, but are not sufficient to discriminate patients at risk for re-tx. With the addition of baseline zMax as a covariate to the RS, prediction for re-tx was improved, although still modest. Further study in larger, multi-center studies are needed to validate these findings and to better understand the risk factors for re-tx in KD in North American children.