Incomplete Kawasaki disease in a 12-month-old girl presenting with cardiac murmur and iron deficiency anemia

An Update on Reports of Atypical Presentations of Kawasaki Disease and the Recognition of IVIG Non-Responder Children

Kawasaki disease (KD) is an acute vasculitis with an intrinsic risk of severe involvement of coronary arteries. The worldwide spread of KD and the importance of early diagnosis for preventing cardiovascular complications have ascertained the need for updating guidelines for prompt disease recognition and treatment efficacy assessment. All KD patients who comply with the definition of classic or atypical disease should be treated with intravenous immunoglobulin (IVIG) soon after diagnosis. The objective of our narrative review was to analyze the medical literature about case reports with atypical KD in relation to diagnosis and potential identification of predictors of non-responsiveness to IVIG. Our analysis has shown that the seminal challenge in KD management is the timeliness of diagnosis, although both extreme variability and transience of clinical manifestations make this goal difficult. A non-negligible percentage of patients, especially in the first 6 months of life, might have atypical manifestations of KD, whose painstaking differential diagnosis may be tricky. Many attempts to develop universal scoring systems and detect children at higher risk of IVIG resistance have been rather unsuccessful. Additionally, KD may show different evolutions according to unraveled demographic, genetic, or epigenetic factors. Further research is needed to elucidate all open questions about KD and clarify the long-term outcome of its potential complications.

Iron deficiency anemia as a predictor of coronary artery abnormalities in Kawasaki disease

PURPOSE

Coronary artery abnormalities (CAA) are the most important complications of Kawasaki disease (KD). Iron deficiency anemia (IDA) is a prevalent micronutrient deficiency and its association with KD remains unknown. We hypothesized that presence of IDA could be a predictor of CAA.

METHODS

This retrospective study included 173 KD patients, divided into 2 groups according to absence (group 1) and presence (group 2) of CAA. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a logistic regression model to estimate the association between CAA and other indicators. Due to collinearity between indicators of IDA, each indicator was paired with anemia in 3 models.

RESULTS

Serum iron, iron saturation, and ferritin concentration, the 3 indicators of IDA, were significantly higher in group 1 than in group 2. Three sets of models including anemia with iron indicators produced the OR of CAA of 3.513, 3.171, and 2.256, respectively. The 3 indicators of IDA were negatively associated with CAA, by OR of 0.965, 0.914, and 0.944, respectively. The areas under the curve (AUCs) of ferritin concentration, iron saturation, serum iron, anemia, and Kobayashi score were 0.907 (95% CI, 0.851-0.963), 0.729 (95% CI, 0.648-0.810), 0.711 (95% CI, 0.629-0.793), 0.638 (95% CI, 0.545-0.731), and 0.563 (95% CI, 0.489-0.636), respectively.

CONCLUSION

Indicators of IDA, especially ferritin, were highly associated with CAA; therefore, they were stronger predictors of CAA than Kobayashi scores. IDA indicators can be used to predict CAA development and to suggest requirements for early interventions.

[Clinical features of children with incomplete Kawasaki disease]

OBJECTIVE

To investigate the clinical features of children with incomplete Kawasaki disease (IKD), and to provide reference for the early diagnosis of IKD.

METHODS

The clinical data of 22 hospitalized children with IKD were analyzed retrospectively and compared with the data of 63 children with Kawasaki disease (KD) who were hospitalized during the same period of time. Another 20 children with pyrexia were enrolled as the control group.

RESULTS

Pyrexia was observed in all children. Compared with the KD group, the IKD group had significantly lower proportions of children with changes in the limbs, conjunctival hyperaemia, and cervical lymphadenectasis (P<0.05), a significantly higher serum level of glutamic-pyruvic transaminase (P<0.05), and significantly lower levels of plasma albumin, serum sodium, and interleukin-6 (P<0.05). There was no significant difference in the rate of γ-globulin application between the IKD and KD groups; however, the IKD group had a significantly higher incidence rate of coronary artery lesion than the KD group (P<0.05).

CONCLUSIONS

The symptoms and signs in children with IKD are untypical. The liver function test and serum hyponatremia and IL-6 measurements may be useful for the diagnosis of IKD.