1
|
Zeinali M, Frishman WH, Aronow WS. Kawasaki Disease. Cardiol Rev 2025:00045415-990000000-00504. [PMID: 40396727 DOI: 10.1097/crd.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2025]
Abstract
Kawasaki disease (KD) is an acute febrile, systemic vasculitis with an unknown etiology that mostly affects children under the age of 5, and it is the most common cause of acquired heart disease in children in developed countries. Despite significant advances in understanding this disease's pathophysiology, diagnostic methods, and treatment options, many aspects remain unclear, so this study aims to provide a comprehensive review of the current knowledge on KD. We reviewed the most recent research (2019-2024) to compile recent advances in the pathogenesis, immunologic mechanisms, clinical manifestations, and treatment of KD, while comparing it with the multisystem inflammatory syndrome in children. KD is associated with elevated inflammatory cytokines, autoantibodies, and endothelial dysfunction, leading to coronary artery lesions. Clinical diagnosis remains challenging and is based on laboratory markers, echocardiography, and differential diagnosis. Intravenous immunoglobulin and high-dose aspirin remain standard treatments, with immunomodulatory therapies for resistant cases. Multisystem inflammatory syndrome in children shares overlapping features but differs in age distribution, systemic involvement, and immune response. Given the critical importance of early diagnosis and management of KD in preventing coronary artery aneurysms, ongoing research is focused on elucidating the underlying mechanisms of the disease and developing novel therapeutic strategies. These efforts aim to enhance patient outcomes and reduce long-term cardiovascular risks.
Collapse
Affiliation(s)
- Maryam Zeinali
- From the Department of Emergency Medicine, Mazandaran University of Medical Sciences, Ramsar, Mazandaran, Iran
| | | | - Wilbert S Aronow
- Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| |
Collapse
|
2
|
Arora M, Barman P, Sahu A, Jindal AK, Singh S. Heliotrope-like rash in a febrile child: think of Kawasaki disease. Rheumatology (Oxford) 2025; 64:906-907. [PMID: 37930877 DOI: 10.1093/rheumatology/kead577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/08/2023] Open
Affiliation(s)
- Munish Arora
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prabal Barman
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Animesh Sahu
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
3
|
Nakayama S, Kambe N, Irie H, Izawa K, Nishijima R, Ueno H, Fujimoto M, Yasumi T, Kabashima K. Psoriasiform Dermatitis Following Kawasaki Disease: A Case Report and Literature Review. Pediatr Dermatol 2024. [PMID: 39727108 DOI: 10.1111/pde.15859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 11/28/2024] [Accepted: 12/15/2024] [Indexed: 12/28/2024]
Abstract
Kawasaki disease (KD) is an idiopathic acute inflammatory illness that commonly affects children in Northeast Asian countries. In this case report, a psoriasiform eruption appeared on the face and extremities following the onset of KD. A review of previous reports identified 38 cases of psoriasiform eruptions following KD, typically appearing 4 days to 2 months after the onset of KD, unlike other skin manifestations associated with the disease. Notably, in this case, the rash improved with the application of white petrolatum, suggesting that psoriasiform eruptions following KD may be self-limited with spontaneous resolution.
Collapse
Affiliation(s)
- Shota Nakayama
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naotomo Kambe
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Center for Allergy, Kyoto University Hospital, Kyoto, Japan
| | - Hiroyuki Irie
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazushi Izawa
- Center for Allergy, Kyoto University Hospital, Kyoto, Japan
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryohei Nishijima
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Hiroo Ueno
- Department of Pediatrics, Kyoto Katsura Hospital, Kyoto, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Takahiro Yasumi
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Japan Environment and Children's Study Kyoto Regional Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
4
|
Khan MH, Ahsan A, Mehta F, Kanawala A, Mondal R, Dilshad A, Akbar A. Precision Medicine in Congenital Heart Disease, Rheumatic Heart Disease, and Kawasaki Disease of Children: An Overview of Literature. Cardiol Rev 2024:00045415-990000000-00257. [PMID: 39819650 DOI: 10.1097/crd.0000000000000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2025]
Abstract
Congenital heart disease and common acquired heart diseases like Kawasaki disease and rheumatic heart disease are prevalent cardiovascular conditions in children worldwide. Despite the availability of treatment options, they continue to be significant contributors to morbidity and mortality. Advancements in early diagnosis, improvements in treatment approaches, and overcoming resistance to available treatments are crucial to reduce morbidity. Researchers have turned to precision medicine to tackle these challenges. We aimed to analyze the existing literature concerning the utilization of precision medicine in congenital heart disease, rheumatic heart disease, and Kawasaki disease. The emphasis is placed on comprehending the key themes explored in these studies and evaluating the present state of their clinical integration. The central theme of most studies revolves around the examination of genetic factors. Despite promising research outcomes, limitations in these studies indicate that the clinical implementation of precision medicine in these conditions remains a distant prospect, necessitating additional exploration and attention to confounding factors.
Collapse
Affiliation(s)
- Muhammad Hamza Khan
- From the Department of Internal Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Areeba Ahsan
- Department of Internal Medicine, Foundation University School of Health Sciences, Islamabad, Pakistan
| | - Fena Mehta
- Department of Internal Medicine, Smt. NHL Municipal Medical College, Ahmedabad, India
| | - Arundati Kanawala
- Department of Internal Medicine, Smt. Kashibai Navale Medical College and General Hospital, Pune, India
| | - Riddhi Mondal
- Department of Internal Medicine, Jagannath Gupta Institute of Medical Sciences and Hospital, Kolkata, India
| | - Aamna Dilshad
- Department of Biological Sciences, International Islamic University, Islamabad, Pakistan
| | - Anum Akbar
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
5
|
Geng R, Yu M, Xu J, Wei Y, Wang Q, Chen J, Sun F, Xu K, Xu H, Liu X, Xiao J, Zhang X, Xie B. Amino acids analysis reveals serum methionine contributes to diagnosis of the Kawasaki disease in mice and children. J Pharm Biomed Anal 2024; 239:115873. [PMID: 38008045 DOI: 10.1016/j.jpba.2023.115873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Kawasaki disease (KD) patients often lack early and definitive diagnosis due to insufficient clinical criteria, whereas biomarkers might accelerate the diagnostic process and treatment. METHODS The KD mouse models were established and thirteen amino acids were determined. A total of 551 serum samples were collected including KD patients (n = 134), HCs (n = 223) and KD patients after intravascular immunoglobulin therapy (IVIG, n = 194). A paired analysis of pre- and post-IVIG was employed in 10 KD patients. RESULTS The pathological alterations of the aorta, myocardial interstitium and coronary artery vessel were observed in KD mice; the serum levels of methionine in KD mice (n = 40) were markedly altered and negatively correlated with the C-reactive protein levels. Consistent with the mouse model, serum methionine were significantly decreased in KD children, with the relative variation ratio of KD with HCs above 30% and AUROC value of 0.845. Serum methionine were correlated with Z-Score and significantly restored to the normal ranges after KD patient IVIG treatment. Another case-control study with 10 KD patients with IVIG sensitivity and 20 healthy controls validated serum methionine as a biomarker for KD patients with AUROC of 0.86. Elevation of serum DNMT1 activities, but no differences of DNMT3a and DNMT3b, were observed in KD patients when comparing with those in the HCs. CONCLUSIONS Our study validated that serum methionine was a potential biomarker for KD, the alteration of which is associated with the activation of DNMT1 in KD patients.
Collapse
Affiliation(s)
- Ruijin Geng
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics and Digital Health of Zhejiang Province, Jiaxing University, Jiaxing 314001, China; School of Pharmaceutical Science, Nanchang University, Nanchang 330001, China
| | - Mengjie Yu
- School of Pharmaceutical Science, Nanchang University, Nanchang 330001, China
| | - Jinbiao Xu
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics and Digital Health of Zhejiang Province, Jiaxing University, Jiaxing 314001, China
| | - Yuanwang Wei
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics and Digital Health of Zhejiang Province, Jiaxing University, Jiaxing 314001, China
| | - Qiong Wang
- Department of Pediatrics, the Second Affiliated Hospital of Jiaxing University, Jiaxing 314001, China
| | - Junguo Chen
- Department of Pediatrics, the Second Affiliated Hospital of Jiaxing University, Jiaxing 314001, China
| | - Fei Sun
- Department of Pediatrics, the Affiliated Hospital of Jiaxing University, Jiaxing 314001, China
| | - Kun Xu
- Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang 330001, China
| | - Han Xu
- Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang 330001, China
| | - Xiaohui Liu
- Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang 330001, China
| | - Juhua Xiao
- Department of Ultrasound, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang 330001, China.
| | - Xianchao Zhang
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics and Digital Health of Zhejiang Province, Jiaxing University, Jiaxing 314001, China.
| | - Baogang Xie
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics and Digital Health of Zhejiang Province, Jiaxing University, Jiaxing 314001, China; School of Pharmaceutical Science, Nanchang University, Nanchang 330001, China.
| |
Collapse
|
6
|
Reddy Konda VV, Jindal AK, Nadig PL, Banday AZ, Vinay K, Singh S. Microvascular changes on nailfold capillaroscopy in acute stage of Kawasaki disease: a new diagnostic paradigm for an enigmatic condition. Rheumatology (Oxford) 2024; 63:392-398. [PMID: 37202349 DOI: 10.1093/rheumatology/kead213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/01/2023] [Accepted: 04/30/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES Kawasaki disease (KD) is a medium vessel vasculitis with a predilection to involve coronary arteries. However, there is a paucity of literature on microvascular changes in patients with KD. METHODS Children diagnosed with KD based on American Heart Association guidelines 2017 were enrolled prospectively. Demographic details and echocardiographic changes in coronaries were recorded. Nailfold capillaries were assessed using Optilia Video capillaroscopy and data were analysed using Optilia Optiflix Capillaroscopy software at acute (prior to IVIG administration) and subacute/convalescent phase. RESULTS We enrolled 32 children with KD (17 boys) with a median age of 3 years. Nailfold capillaroscopy (NFC) was performed in 32 patients in the acute phase (compared with 32 controls) and in 17 during the subacute/convalescent phase at a median follow-up of 15 (15-90) days after IVIG treatment. The following findings were seen in NFC in the acute phase of KD: reduced capillary density (n = 12, 38.6%), dilated capillaries (n = 3, 9.3%), ramifications (n = 3, 9.3%) and capillary haemorrhages (n = 2, 6.2%). Capillary density was reduced significantly in the acute phase of KD (38.6%) as compared with the subacute/convalescent phase (25.4%) (P-value <0.001) and controls (0%) (P-value = 0.03). We observed no correlation between coronary artery involvement and mean capillary density (P = 0.870). CONCLUSION Results show that patients with KD have significant nailfold capillary changes in the acute phase. These findings may provide a new diagnostic paradigm for KD and a window to predict coronary artery abnormalities.
Collapse
Affiliation(s)
- Vishnu Vardhan Reddy Konda
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pallavi L Nadig
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aaqib Zaffar Banday
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venerology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
7
|
Barman P, Nadig PL, Samynathan P, Jindal AK, Singh S. Malar rash in a febrile infant: is this Kawasaki disease? Rheumatology (Oxford) 2024; 63:e24-e25. [PMID: 37436704 DOI: 10.1093/rheumatology/kead338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023] Open
Affiliation(s)
- Prabal Barman
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pallavi L Nadig
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prasanna Samynathan
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
8
|
Sekerel BE, Ilgun Gurel D, Sahiner UM, Soyer O, Kocaturk E. The many faces of pediatric urticaria. FRONTIERS IN ALLERGY 2023; 4:1267663. [PMID: 38026129 PMCID: PMC10655015 DOI: 10.3389/falgy.2023.1267663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Urticaria is a common disease that can affect individuals of all age groups, with approximately one-quarter of the population experiencing it at least once in their lifetime. Lesions characterized by erythema and itchy hives can appear anywhere on the body. These can vary in size ranging from millimeters to centimeters, and typically clear within 24 h. About 40% of patients with urticaria have accompanying angioedema, which involves localized deep tissue swelling. Urticaria usually occurs spontaneously and is classified into acute and chronic forms, with the latter referring to a condition that lasts for more than 6 weeks. The prevalence of chronic urticaria in the general population ranges from 0.5% to 5%, and it can either be inducible or spontaneous. The most common form of pediatric urticaria is acute and is usually self-limiting. However, a broad differential diagnosis should be considered in children with urticaria, particularly if they also have accompanying systemic complaints. Differential diagnoses of pediatric urticaria include chronic spontaneous urticaria, chronic inducible urticaria, serum sickness-like reaction, urticarial vasculitis, and mast cell disorders. Conditions that can mimic urticaria, including but not limited to cryopyrinopathies, hyper IgD syndrome, Periodic Fever, Aphthous Stomatitis, Pharyngitis and Adenitis (PFAPA), Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPs), and Schnitzler syndrome should also be considered. The many faces of pediatric urticaria can be both easy and confusing. A pragmatic approach relies on clinical foresight and understanding the various forms of urticaria and their potential mimickers. This approach can pave the way for an accurate and optimized diagnostic approach in children with urticaria.
Collapse
Affiliation(s)
- Bulent Enis Sekerel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Deniz Ilgun Gurel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Umit Murat Sahiner
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Ozge Soyer
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Türkiye
| | - Emek Kocaturk
- Department of Allergology, Charite University School of Medicine, Berlin, Germany
| |
Collapse
|
9
|
Galeotti C, Bajolle F, Belot A, Biscardi S, Bosdure E, Bourrat E, Cimaz R, Darbon R, Dusser P, Fain O, Hentgen V, Lambert V, Lefevre-Utile A, Marsaud C, Meinzer U, Morin L, Piram M, Richer O, Stephan JL, Urbina D, Kone-Paut I. French national diagnostic and care protocol for Kawasaki disease. Rev Med Interne 2023:S0248-8663(23)00647-1. [PMID: 37349225 DOI: 10.1016/j.revmed.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/04/2023] [Indexed: 06/24/2023]
Abstract
Kawasaki disease (KD) is an acute vasculitis with a particular tropism for the coronary arteries. KD mainly affects male children between 6 months and 5 years of age. The diagnosis is clinical, based on the international American Heart Association criteria. It should be systematically considered in children with a fever, either of 5 days or more, or of 3 days if all other criteria are present. It is important to note that most children present with marked irritability and may have digestive signs. Although the biological inflammatory response is not specific, it is of great value for the diagnosis. Because of the difficulty of recognising incomplete or atypical forms of KD, and the need for urgent treatment, the child should be referred to a paediatric hospital as soon as the diagnosis is suspected. In the event of signs of heart failure (pallor, tachycardia, polypnea, sweating, hepatomegaly, unstable blood pressure), medical transfer to an intensive care unit (ICU) is essential. The standard treatment is an infusion of IVIG combined with aspirin (before 10 days of fever, and for a minimum of 6 weeks), which reduces the risk of coronary aneurysms. In case of coronary involvement, antiplatelet therapy can be maintained for life. In case of a giant aneurysm, anticoagulant treatment is added to the antiplatelet agent. The prognosis of KD is generally good and most children recover without sequelae. The prognosis in children with initial coronary involvement depends on the progression of the cardiac anomalies, which are monitored during careful specialised cardiological follow-up.
Collapse
Affiliation(s)
- C Galeotti
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
| | - F Bajolle
- M3C-Necker-Enfants-Malades, hôpital Necker-Enfants-Malades, université de Paris Cité, Paris, France
| | - A Belot
- Service de néphrologie, rhumatologie et dermatologie pédiatriques, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), hôpital Femme-Mère-Enfant, hospices civils de Lyon, Lyon, France
| | - S Biscardi
- Service des urgences pédiatriques, centre hospitalier intercommunal de Créteil, Créteil, France
| | - E Bosdure
- Service de spécialités pédiatriques et médecine infantile, CHU Timone-Enfants, 13385 Marseille cedex 5, France
| | - E Bourrat
- Service de pédiatrie générale, maladies infectieuses et médecine interne, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant, hôpital universitaire Robert-Debré, université hospital, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - R Cimaz
- Pediatric Rheumatology Unit, Gaetano Pini Hospital, Department of Clinical Sciences and Community Health, Research Centre for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - R Darbon
- Association France vascularites, Blaisy-Bas, France
| | - P Dusser
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - O Fain
- Service de médecine interne, hôpital Saint-Antoine, Sorbonne université, AP-HP, 75012 Paris, France
| | - V Hentgen
- Service de pédiatrie, centre de référence des maladies auto-inflammatoires et de l'amylose (CEREMAIA), centre hospitalier de Versailles, Le Chesnay, France
| | - V Lambert
- Service de radiologie pédiatrique, Institut mutualiste Montsouris, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | - A Lefevre-Utile
- Service de pédiatrie générale et des urgences pédiatriques, hôpital Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), Bondy, France
| | - C Marsaud
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - U Meinzer
- Service de pédiatrie générale, maladies infectieuses et médecine interne, centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant, hôpital universitaire Robert-Debré, université hospital, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - L Morin
- Service de réanimation pédiatrique et néonatale, DMU 3 santé de l'enfant et adolescent, hôpital Bicêtre, université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France
| | - M Piram
- Division of Dermatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, Montréal, Quebec, Canada
| | - O Richer
- Service des urgences pédiatriques, hôpital universitaire de Pellegrin, Bordeaux, France
| | - J-L Stephan
- Service de pédiatrie, CHU Saint-Étienne, Saint-Étienne, France
| | - D Urbina
- Service d'accueil des urgences pédiatriques, hôpital Nord, AP-HM, 13005 Marseille, France
| | - I Kone-Paut
- Service de rhumatologie pédiatrique, centre de référence des maladies auto-inflammatoires rares et des amyloses, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| |
Collapse
|
10
|
Akçay N, Topkarcı Z, Menentoğlu ME, Oğur M, Sofuoğlu Aİ, Boydağ Güvenç K, Baydemir C, Şevketoğlu E. New dermatological findings of MIS-C: Can mucocutaneous involvement be associated with Severe Disease Course? Australas J Dermatol 2022; 63:228-234. [PMID: 35290661 DOI: 10.1111/ajd.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about mucocutaneous involvement in critically ill patients with the multisystem inflammatory syndrome in children (MIS-C). The aim of our study was to describe the localisation and variety of rash and to investigate whether presenting with rash at admission alters the clinical course of MIS-C. METHODS This prospective, observational cohort study was conducted amongst children under 18 years of age who were admitted to our paediatric intensive care unit (PICU) between May 2020 and May 2021 with a possible diagnosis of MIS-C. RESULTS A total of 33 children with MIS-C, 21 boys (64%), with a median age of 9.4 years (3.4-11.5) were enrolled. Twenty-four children presented with mucocutaneous symptoms (72%). Age, male gender, PICU length of stay, presenting symptoms, inotrope requirement, the existence of myocarditis or respiratory failure were higher but not significantly different in patients with rash compared to those without rash (P > 0.05). The median duration of symptoms before admission and presence of cervical lymphadenopathy were significantly higher in patients than those without rash (P < 0.05). Children with a rash had a significantly higher neutrophil count, CRP, procalcitonin, troponin levels and lower lymphocyte counts and albumin levels than those without rash (P < 0.05). Twelve children with rash (50%) had symmetrical intertriginous distribution. Two children had erythematous lesions on the areola and the surroundings. In conclusion, intertriginous involvement, periareolar erythema and other mucocutaneous manifestations might be the first alarming symptoms of moderate to severe MIS-C. Therefore, close monitoring with a multidisciplinary approach should be considered for these patients to assess potential disease progression.
Collapse
Affiliation(s)
- Nihal Akçay
- Department of Pediatric Intensive Care Unit, Bakırkoy Dr Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zeynep Topkarcı
- Department of Dermatology, Bakirkoy Dr Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Emin Menentoğlu
- Department of Pediatric Intensive Care Unit, Bakırkoy Dr Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Oğur
- Department of Pediatric Intensive Care Unit, Bakırkoy Dr Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ayşe İrem Sofuoğlu
- Department of Pediatric Intensive Care Unit, Bakırkoy Dr Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kübra Boydağ Güvenç
- Department of Pediatric Intensive Care Unit, Bakırkoy Dr Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Canan Baydemir
- Department of Biostatistics, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Esra Şevketoğlu
- Department of Pediatric Intensive Care Unit, Bakırkoy Dr Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
11
|
Moreno-Espinosa S, Rivera-Rodríguez L, Gámez-González LB, Chavez-Priego R, Yamazaki-Nakashimada MA. Malar rash in multisystemic inflammatory syndrome in children. Pediatr Int 2022; 64:e15309. [PMID: 36271769 DOI: 10.1111/ped.15309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/25/2022] [Accepted: 06/11/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Sarbelio Moreno-Espinosa
- Pediatric Department, Hospital Médica Sur, Mexico City, Mexico.,Department of Education, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Leonardo Rivera-Rodríguez
- Pediatric Department, Hospital Médica Sur, Mexico City, Mexico.,Pediatric Cardiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | | | - Marco Antonio Yamazaki-Nakashimada
- Pediatric Department, Hospital Médica Sur, Mexico City, Mexico.,Clinical Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| |
Collapse
|
12
|
Shipman AR. Putting the spotlight on paediatric dermatology. Clin Exp Dermatol 2021; 46:419. [PMID: 33382127 DOI: 10.1111/ced.14546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
- A R Shipman
- Dermatology Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK.,Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| |
Collapse
|