Abstract

Background: Kawasaki disease is a well known entity in pediatric age group and so is its counterpart Multisystem Inflammatory Syndrome in Children (MIS-C). MIS-C term became more popular during covid era as the infection started to affect pediatric age group. Now, a large number pediatricians have seencases of MIS-C. Reactivation of BCG scar is less commonly seen in Kawasaki disease and rare to never in a case of MIS-C. Case Presentation: We report a 6-month-old male child who presented with cold and fever. Covid Rapid Antigen Test (RAT) and Covid RTPCR were negative. He continued to have high grade feverwhich is unusual for a case of bronchiolitis and started on antibiotics. Clinical suspicion of MIS-C made and started to work up for the same. Examination revealed reactivation at BCG site with pealing of skin. Further investigations showed elevated CRP and d-dimer with positive anti-SARS COV2 antibody. Diagnosis of MIS-C confirmed and treated with methylprednisolone and IVIG. Conclusion: Reactivation at BCG site is well known entity in Kawasaki disease and as a post vaccination immune cross reactivity. But never reported in a case of MIS-C as less known abouthuman immunological response towards Covid-19 infection and its sequel. It can be considered as an early diagnostic tool in resource poor settings and at community level.

• 1.   Dufort EM, Koumans EH, Chow EJ, et al (2020) Multisystem inflammatory syndrome in children in New York State. New Engl J Med. 383:347–358.
• 2.   Higgins JP, Soares-Weiser K, Lopez-Lopez J, et al (2016) Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review. Bmj.355:1-13.
• 3.   Organization W. Global COVID-19 clinical platform: case record form for suspected cases of multisystem inflammatory syndrome (MIS) in children and adolescents temporally related to COVID-19, 01 June 2020 [Internet]. Apps.who.int. 2022 [cited 2 April 2022]. Available from: https://apps.who.int/iris/ handle/10665/332236.
• 4.   Newburger J, Takahashi M, Gerber M, et al (2004) Diagnosis, treatment and long term management of Kawasaki Disease. Circulation.110:2747–2771.
• 5.   Roth A, Gustafson P, Nhaga A, et al (2005) BCG vaccination scar associated with better childhood survival in Guinea-Bissau. Int J Epidemiol.34(3):540-547.
• 6.   Schaltz-Buchholzer F, Berendsen M, Roth A, et al (2020) BCG skin reactions by 2 months of age are associated with better survival in infancy: a prospective observational study from GuineaBissau. BMJ Global Health.5(9):e002993.
• 7.   Biering-Sørensen S, Aaby P, Lund N, et al (2017) Early BCG-Denmark and Neonatal Mortality Among Infants Weighing <2500 g: A Randomized Controlled Trial. Clin Infect Dis.65(7):1183-1190.
• 8.   Muthuvelu S, Lim K, Huang L, et al (2019) Measles infection causing Bacillus CalmetteGuérin reactivation: a case report. BMC Pediatr.19(1):251.
• 9.   Loh ACE, Kua PHJ, Tan ZL (2019) Erythema and induration of the Bacillus CalmetteGuérin site for diagnosing Kawasaki disease. Singapore Med J.60(2):89–93.
• 10.   Rezai MS, Shahmohammadi S (2014) Erythema at BCG inoculation site in Kawasaki disease patients. Mater Sociomed.26(4):256–260.
• 11.   Jiang L, Tang K, Levin M, et al (2020) COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis.20(11):e276-e288.
• 12.   Eggenhuizen P, Ng B, Chang J, et al (2021) BCG Vaccine Derived Peptides Induce SARSCoV-2 T Cell Cross-Reactivity. Frontiers in Immunology.12:692729.
• 13.   Mohamed L, Madsen A, Schaltz-Buchholzer F, et al (2021) Reactivation of BCG vaccination scars after vaccination with mRNA-Covidvaccines: two case reports. BMC Infectious Diseases. 21(1):1264.
• 14.   Cheng YW Wong LM, So KT (2003) Update on Kawasaki disease in Hong Kong. HK Pract.25:127–133.

Data Sharing Statement

Funding