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The diagnosis of Kawasaki disease (KD) is challenging as it requires the identification of specific signs and symptoms through physicians’ subjective evaluations. Thus, we aimed to evaluate the influence of cognitive bias on pediatricians’ identification of KD signs. Seventy-five pediatricians were randomly divided into two groups and asked to examine photographs of healthy children’s eye, tongues, and fingertips with different case histories suggesting either Kawasaki disease (KD) or the common cold. Of the 75 pediatricians, 28 responded to the questionnaire. The 14 pediatricians were given KD-suggestive histories; the others were given common cold-suggestive histories. The group that was given KD-suggestive histories was more likely to misdiagnose healthy children’s eye (85.7% vs 50.0%, p = 0.043), tongues (35.7% vs 7.1%, p = 0.065), and fingertips (85.7% vs 35.7%, p = 0.007) as positive KD signs in the photographs than that were given common cold-suggestive histories. We found that medical histories suggestive of KD can cause cognitive bias in physicians when identifying KD signs in photographs.

Background The initial symptoms of Guillain-Barre Syndrome (GBS) can be similar to a case of spontaneous spinal epidural hematoma (SSEH) located at the cervicothoracic junction. Therefore, SSEH may be misdiagnosed as GBS. Case Report: A previously healthy 6-year-old girl presented with a 2-day history of progressive pain in the lower extremities and an inability to walk. On initial evaluation, she was completely paraparetic in the lower extremities. Deep tendon reflexes were absent in the lower extremities, and Babinski reflexes were positive on both sides. She exhibited reduced response to light touch and pinprick with a sensory level below T10, and experienced difficulty during urination. However, the strength, sensation and flexion of upper extremities were normal. Because her presentation and examinations were consistent with GBS, we initiated intravenous immunoglobulin therapy. The next day, she also developed pain and muscle weakness of the right upper extremity. Three days after admission, respiratory depression progressed rapidly. Spinal MRI showed a mass extending from the level of C7-T3, with spinal cord compression. The patient underwent an emergency laminectomy with evacuation of hematoma, and was diagnosed with SSEH. Sixty days after admission, she was transferred to the rehabilitation hospital with severe neurologic sequelae of paralysis in both legs. Conclusion: SSEH might have severe consequences, including neurologic deficits and risk of death. This case report serves to raise the awareness of SSEH that mimics the initial presentation of GBS.

To improve severe ketoacidosis with COVID‐19, insulin treatment, invasive mechanical ventilation therapy, and continuous hemodiafiltration with sodium bicarbonate infusion were effective.