Dear Editor,

I would like to discuss on “Covid-19 and Kawasaki Syndrome: Should We Really Be Surprised?^{Reference Loomba, Villarreal and Flores1}” Loomba et al. concluded that it was no surprising that there might be an association between the novel coronavirus infection and Kawasaki syndrome.Reference Loomba, Villarreal and Flores¹ Indeed, it is no doubt for possible association since many viruses can induce Kawasaki syndrome. Nevertheless, the surprising issue should be the discrepancies in clinical presentation in different settings. It is interesting that there is no report on Kawasaki-like syndrome in COVID-19 patients during its first phase of pandemic in East Asia and Southeast Asia. The problem was first noted when the disease came to the West. The underlying genetic factor might be a factor that cause more common Kawasaki-like syndrome in non-Asian population. Indeed, the intravenous immunoglobulin unresponsiveness in non-Asian patients with Kawasaki disease is reported and the difference varied among different ethnic groups.^{Reference Piram, Darce Bello, Tellier, Di Filippo, Boralevi, Madhi, Meinzer, Cimaz, Piedvache and Koné-Paut2}