To the Editor: Kawasaki disease (KD) is a medium-vessel vasculitis usually presenting in 6 mo–5 y age group [1]. Clinical presentation in infancy and beyond 5 y is characterised by incomplete or atypical features [2, 3]. Before the pandemic, the adolescents represented only 1%–7% of all KD.

An 11-y-old girl had fever, diarrhea and vomiting for 5 d. She had maculopapular rash, cracked red lips and tongue with conjunctival injection. She had cold shock. Investigations showed anemia, neutrophilic leucocytosis, and raised inflammatory markers, transaminitis, hypoalbuminemia, and AKI. The N-terminal-pro-Brain natriuretic peptide (NT-proBNP) was 1925 pg/mL and she fulfilled the criteria for MAS as per Ravelli criteria [4]. COVID serology was borderline positive with levels of 26.4 AU/mL. Echocardiography showed moderate mitral regurgitation (MR) and pericardial effusion. We administered intravenous immunoglobulin at 2 g/kg and methylprednisolone pulse. Patient responded well to therapy.

A 16-y-old male child had fever and rash for 5 d along with eye redness. On examination child was in cold shock. There was erythematous rash and conjunctival injection. He had neutrophilic leukocytosis, thrombocytopenia, AKI, metabolic acidosis, raised CRP, and increased NT-proBNP. COVID serology was highly positive (> 100 AU/mL) suggestive of MIS-C. He responded well to intravenous immunoglobulin and methylprednisolone pulse.

A 13-y-old female child had fever, loose stools, and vomiting for 7 d. On examination she had cold shock. On examination she had eye redness and cracking of lips. On investigations she had anemia, neutrophilic leukocytosis, thrombocytopenia, raised inflammatory markers, and AKI. COVID RT-PCR was positive. We treated with immunoglobulin, methylprednisolone pulses, and enoxaparin. She responded well to therapy.

We have presented 3 cases with KD phenotype in adolescents, with varying association with SARS-CoV-2 infection. Treatment with IVIG and steroids may be life-saving.