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ResearchIn-Press PreviewCOVID-19Immunology Free access | 10.1172/JCI144554

Similarities and differences between the immunopathogenesis of COVID-19-related pediatric inflammatory multisystem syndrome and Kawasaki disease

Ana Esteve-Sole,1 Jordi Anton,2 Rosa Maria Pino-Ramírez,3 Judith Sanchez-Manubens,4 Victoria Fumadó,5 Clàudia Fortuny,5 María Rios-Barnes,5 Joan Sanchez-de-Toledo,6 Mónica Girona-Alarcón,7 Juan M. Mosquera,4 Silvia Ricart,3 Cristian Launes,3 Mariona Fernández de Sevilla,3 Cristina Jou,2 Carmen Muñoz-Almagro,8 Eva González-Roca,9 Andrea Vergara,10 Jorge Carrillo,11 Manel Juan,12 Daniel Cuadras,13 Antoni Noguera-Julian,5 Iolanda Jordan,14 and Laia Alsina1

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

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1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Anton, J. in: JCI | PubMed | Google Scholar |

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Pino-Ramírez, R. in: JCI | PubMed | Google Scholar |

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Sanchez-Manubens, J. in: JCI | PubMed | Google Scholar

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Fumadó, V. in: JCI | PubMed | Google Scholar

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Fortuny, C. in: JCI | PubMed | Google Scholar

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Rios-Barnes, M. in: JCI | PubMed | Google Scholar

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Sanchez-de-Toledo, J. in: JCI | PubMed | Google Scholar |

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Girona-Alarcón, M. in: JCI | PubMed | Google Scholar

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Mosquera, J. in: JCI | PubMed | Google Scholar

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Ricart, S. in: JCI | PubMed | Google Scholar

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Launes, C. in: JCI | PubMed | Google Scholar |

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by de Sevilla, M. in: JCI | PubMed | Google Scholar

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Jou, C. in: JCI | PubMed | Google Scholar

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

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1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

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1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Vergara, A. in: JCI | PubMed | Google Scholar |

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Carrillo, J. in: JCI | PubMed | Google Scholar |

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Juan, M. in: JCI | PubMed | Google Scholar |

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Cuadras, D. in: JCI | PubMed | Google Scholar |

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

Find articles by Noguera-Julian, A. in: JCI | PubMed | Google Scholar |

1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

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1Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain

2Institut de Recerca, Hospital Sant Joan de Déu, Barcelona, Spain

3Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain

4Pediatric Rheumatology Department, Hospital Sant Joan de Déu, Barcelona, Spain

5Infectious Diseases Department, Hospital Sant Joan de Déu, Barcelona, Spain

6Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, United States of America

7Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

8Molecular Microbiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

9Molecular Biology Core, CDB, HCB-IDIBAPS, Barcelona, Spain

10Microbiology Department, CDB, HCB, Barcelona, Spain

11IrsiCaixa, AIDS Research Institute, Badalona, Spain

12Department of Immunology-CDB, HCB-IDIBAPS, Barcelona, Spain

13Statistical Department, Fundació Sant Joan de Déu, Barcelona, Spain

14Cardiology Department, Hospital Sant Joan de Déu, Barcelona, Spain

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Published January 26, 2021 - More info

J Clin Invest. https://doi.org/10.1172/JCI144554.
Copyright © 2021, American Society for Clinical Investigation
Published January 26, 2021 - Version history
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Abstract

Multisystem inflammatory syndrome associated with the SARS-CoV-2 pandemic has recently been described in children (MIS-C), partially overlapping with Kawasaki disease (KD). We hypothesized that: 1) MIS-C and pre-pandemic KD cytokine profiles may be unique and justify the clinical differences observed; 2) SARS-CoV-2-specific immune complexes (IC) may explain the immunopathology of MIS-C. Seventy-four children were included: 14 MIS-C; 9 patients with positive SARS-CoV-2-PCR without MIS-C (COVID); 14 pre-pandemic KD and 37 healthy controls (HC). Thirty-four circulating cytokines were quantified in pre-treatment serum or plasma samples and the presence of circulating SARS-CoV-2 IC was evaluated in MIS-C patients. Compared to HC, MIS-C and KD groups showed most cytokines to be significantly elevated, with IFN-γ-induced response markers (including IFN-γ, IL-18, IP-10) and inflammatory monocytes activation markers (including MCP-1, IL-1α, IL-1RA) being the main triggers of inflammation. With linear discriminant analysis, MIS-C and KD profiles overlapped; however, a subgroup of MIS-C patients (MIS-Cplus) differentiated from the remaining MIS-C patients in IFN-γ, IL-18, GM-CSF, RANTES, IP-10, IL-1α and SDF-1 and incipient signs of macrophagic activation syndrome. Circulating SARS-CoV-2-IC were not detected in MIS-C patients. Our findings suggest a major role of IFN-γ in the pathogenesis of MIS-C, which may be relevant for therapeutic management.

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