They also share with MIS-C and severe cases of COVID-19 high levels both of ferritin (released by neutrophils) and of haemophagocytosis.The frequent gastrointestinal presentation and mesenteric lymph node inflammation are in keeping with the known liking of SARS-CoV-2 to replicate in enterocytes. Association of Kawasaki-like disease with COVID-19 could support the view that SARS-CoV-2 can cause systemic vasculitis by targeting endothelial tissue via angiotensin-converting enzyme 2 (ACE2), the protein which the virus uses to gain access to cells. While the initial infection is known to be capable of causing acute myocardial damage, occurrence of myocarditis could also plausibly be linked to systemic hyperinflammation triggered by a disorderly post-infectious immune response. It has been suggested that SARS-CoV-2 might lead to immune-mediated damage to the heart and coronary arteries via immune complexes or increased T-cell responses.Understanding the pathophysiology is a key research priority. Questions regarding the underlying molecular mechanisms that lead to the disorder following exposure to SARS-CoV-2 include identification of: any genetic predisposition factors; any associations with particular viral variant/s; any molecular patterns capable of triggering the autoimmune/autoinflammatory responses. Another key question is whether the molecular mechanisms that trigger autoimmune/autoinflammatory responses in children with PMIS and adults with severe COVID-19 (including the induction of high concentrations of IL-6) are similar or distinct.A potential link with Kawasaki disease is under discussion.
An editorial commentary urged clinicians to have a high level of diagnostic suspicion and follow  WHO and CDC definitions to facilitate timely identification and treatment of cases.During July, suspected cases were being flagged and reported in Mumbai, in Delhi, Chennai, and elsewhere. In Pakistan, at least 24 children were said to have Kawasaki-like symptoms in Lahore, where 8 cases fulfilling WHO criteria were prospectively identified by 30 June. In Kazakhstan, 14 cases were confirmed by 20 August (among 2,357 children known to have been infected). Cases have been recorded in Israel, including one of a child who presented with severe central nervous system involvement and complement deficiency. In Turkey, four children with a Kawasaki-like disease probably associated with COVID-19 are reported to have been admitted to the childrens hospital of Hacettepe University in Ankara between 13 April and 11 July. In Algeria, a first case was recorded in June. In Egypt, on 10 July the authorities denied rumours of the existence of cases of Kawasaki-like disease in the country. In South Africa, the first 23 affected children were treated in Cape Town – the initial epicentre of the national COVID-19 epidemic – between 4 June and 24 July. In Ecuador, the Ministry of Health announced on 19 July the presence of 46 probable cases.