Kawasaki Disease Shock Syndrome Presented with Giant Coronary Artery Dilatation – Presentation of Two Cases and a Literature Review

BACKGROUND: Kawasaki disease is an acute, self-limited vasculitis of childhood characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in approximately 15 to 25% of untreated children with the disease and may lead to myocardial infarction, sudden death, or ischemic heart disease. Despite an overlap of clinical features with toxic shock syndrome, children with Kawasaki disease generally do not develop shock. OBJECTIVE: Here we present two adolescent boys who had KDSS and discuss their differentiating features from MIS-C. CASE REPORTS: Two adolescent children presented with a toxic shock-like illness, and were subsequently diagnosed with Kawasaki disease shock syndrome when coronary artery abnormalities were found on transthoracic echocardiography. CONCLUSION: Pediatricians and paediatric cardiologists alike should be aware of this potentially severe form of manifestation of the Kawasaki disease which needs to be differentiated from the multisystem inflammatory syndrome in children.