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Thadchanamoorthy V, Dayasiri K, Ragunathan IR. Atypical Kawasaki disease presenting with macroscopic hematuria in an infant: a case report. J Med Case Rep 2023; 17:10. [PMID: 36627702 PMCID: PMC9832730 DOI: 10.1186/s13256-022-03739-3] [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: 11/26/2020] [Accepted: 12/27/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Kawasaki disease is an acute febrile condition in children. It affects mainly children under 5 years old, and is known to cause coronary artery abnormalities if treatment is delayed. The diagnosis rests mainly on clinical criteria. However, it is also known that some infants do not have diagnostic criteria sufficient enough for the diagnosis of Kawasaki disease. Further, children may rarely present with unusual features, and this entity is recognized as "Atypical Kawasaki disease." CASE PRESENTATION We present the case of a 9-month-old Tamil boy who presented with sterile gross hematuria in association with prolonged fever, lymphadenopathy, and generalized maculopapular rash. He had high inflammatory markers and echocardiogram disclosed left coronary artery dilatation. The diagnosis of incomplete Kawasaki disease was confirmed based on clinical grounds supported by investigations and exclusion of differential diagnosis. The child showed a good response to intravenous immunoglobulin and aspirin. CONCLUSION Kawasaki disease is one of the important differential diagnoses of protracted fever of unknown origin in very young children. Since delayed treatment is associated with a high risk of complications, atypical Kawasaki disease needs to be suspected in children presenting with unusual features such as macroscopic hematuria that occurs in association with unexplained prolonged fever.
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Affiliation(s)
- V. Thadchanamoorthy
- grid.443373.40000 0001 0438 3334Faculty of Health Care Sciences, Eastern University, Chenkalady, Sri Lanka
| | - Kavinda Dayasiri
- grid.45202.310000 0000 8631 5388Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
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Grasa CD, Fernández-Cooke E, Sánchez-Manubens J, Carazo-Gallego B, Aracil-Santos J, Anton J, Lirola MJ, Mercader B, Villalobos E, Bustillo M, Giralt G, Rocandio B, Escribano LM, Domínguez-Rodríguez S, Calvo C. Kawasaki disease in children younger than 6 months of age: characteristics of a Spanish cohort. Eur J Pediatr 2022; 181:589-598. [PMID: 34459958 DOI: 10.1007/s00431-021-04215-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/20/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022]
Abstract
A retrospective study that compared children younger than 6 months versus older children of a Spanish cohort of patients diagnosed with Kawasaki disease between 2011 and 2016 (Kawa-Race study). From the 598 patients recruited, 42 patients were younger than 6 months (7%) and presented more frequently with an incomplete diagnosis of Kawasaki disease (52.4 vs 27.9%, p = 0.001). Cardiac abnormalities detected by echocardiography were more common in younger patients (52.4 vs 30%, p = 0.002). These younger patients presented with a higher proportion of coronary aneurysms as well (19 vs 8.6%, p < 0.001). Shock at diagnosis (9.5 vs 1.9%, p = 0.016) and admission to intensive care units (17.7 vs 4.1%, p = 0.003) were more frequent in patients younger than 6 months. There were no statistically significant differences in relation to infections, non-response to IVIG, or mid- or long-term outcomes.Conclusion: Data of the Spanish cohort are consistent with other American and Asian studies, although Spanish children younger than 6 months had a lower rate of non-response to IVIG and better clinical outcomes. A high index of suspicion should be considered for this population due to a higher risk of coronary abnormalities, presentation of shock, and admission to the intensive care unit. What is Known: •Children below 6 months of age with Kawasaki disease (KD) have different features compared to older. •Younger patients usually have an incomplete form of KD and coronary artery abnormalities. What is New: •Younger than 6 months with KD presented with shock and required admission to PICU more frequently compared to older. •Infections play a similar role in KD despite the age of the patients.
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Affiliation(s)
- Carlos D Grasa
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Pº Castellana, 261, 28046, Madrid, Spain.
| | - Elisa Fernández-Cooke
- Pediatric Research and Clinical Trial Unit (UPIC), Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario, 12 Octubre, Madrid, Spain.,imas2, Instituto de Investigación Sanitaria Hospital, 12 de Octubre, Madrid, Spain.,RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain
| | | | - Begoña Carazo-Gallego
- Department of Pediatric Infectious Diseases, Hospital Regional Universitario, Malaga, Spain
| | - Javier Aracil-Santos
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Pº Castellana, 261, 28046, Madrid, Spain
| | - Jordi Anton
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - María José Lirola
- Department of Pediatric Rheumatology, Instituto Hispalense de Pediatría, Seville, Spain
| | - Beatriz Mercader
- Department of Pediatrics, Hospital Virgen de La Arrixaca, Murcia, Spain
| | | | - Matilde Bustillo
- Department of Pediatric Infectious Diseases, Hospital Miguel Servet, Zaragoza, Spain
| | - Gemma Giralt
- Department of Pediatric Cardiology, Hospital Vall D'Hebron, Barcelona, Spain
| | - Beatriz Rocandio
- Department of Pediatrics, Hospital Universitario Donostia, San Sebastián, Spain
| | - Lucía M Escribano
- Department of Pediatric Cardiology, Hospital General de Albacete, Albacete, Spain
| | - Sara Domínguez-Rodríguez
- Pediatric Research and Clinical Trial Unit (UPIC), Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario, 12 Octubre, Madrid, Spain.,imas2, Instituto de Investigación Sanitaria Hospital, 12 de Octubre, Madrid, Spain
| | - Cristina Calvo
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz, Pº Castellana, 261, 28046, Madrid, Spain.,RITIP, Spanish Network for the Research in Pediatric Infectious Diseases, Madrid, Spain.,IdiPaz, Institute for Health Research From La Paz Hospital, Madrid, Spain
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Thadchanamoorthy V, Dayasiri K. Refractory Kawasaki Disease Presenting With Erythema at Bacille Calmette-Guérin Inoculation Site: A Paediatric Case Report. Cureus 2020; 12:e10928. [PMID: 33194494 PMCID: PMC7659888 DOI: 10.7759/cureus.10928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Kawasaki disease (KD) is an autoimmune disease that generally affects children under the age of five years. It has a variety of clinical manifestations which may be either specific or nonspecific. Intravenous immunoglobulin and aspirin are the mainstays of treatment. There are unusual circumstances where patients are resistant to conventional treatment. We report a one-year-old girl who presented with a 12-day history of fever in association with erythema at the site of Bacille Calmette-Guérin (BCG) scar. She did not respond successfully to conventional treatment although she was diagnosed to have Kawasaki disease. Eventually, she responded to intravenous methylprednisolone and was diagnosed as having refractory Kawasaki disease.
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Liu XP, Huang YS, Kuo HC, Xia HB, Yi-Sun, Huang WD, Lang XL, Liu CY, Liu X. A novel nomogram model for differentiating Kawasaki disease from sepsis. Sci Rep 2020; 10:13745. [PMID: 32792679 PMCID: PMC7427092 DOI: 10.1038/s41598-020-70717-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 03/16/2020] [Indexed: 02/07/2023] Open
Abstract
Kawasaki disease (KD) is a form of systemic vasculitis that occurs in children under the age of 5 years old. Due to prolonged fever and elevated inflammatory markers that are found in both KD and sepsis, the treatment approach differs for each. We enrolled a total of 420 children (227 KD and 193 sepsis) in this study. Logistic regression and a nomogram model were used to analyze the laboratory markers. We randomly selected 247 children as the training modeling group and 173 as the validation group. After completing a logistic regression analysis, white blood cell (WBC), anemia, procalcitonin (PCT), C-reactive protein (CRP), albumin, and alanine transaminase (ALT) demonstrated a significant difference in differentiating KD from sepsis. The patients were scored according to the nomogram, and patients with scores greater than 175 were placed in the high-risk KD group. The area under the curve of the receiver operating characteristic curve (ROC curve) of the modeling group was 0.873, sensitivity was 0.893, and specificity was 0.746, and the ROC curve in the validation group was 0.831, sensitivity was 0.709, and specificity was 0.795. A novel nomogram prediction model may help clinicians differentiate KD from sepsis with high accuracy.
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Affiliation(s)
- Xiao-Ping Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Yi-Shuang Huang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Ho-Chang Kuo
- Kawasaki Disease Center and Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, #123, Dapei Rd., Niaosong, Kaohsiung, 83301, Taiwan
| | - Han-Bing Xia
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Yi-Sun
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Wei-Dong Huang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Xin-Ling Lang
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China
| | - Chun-Yi Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China.
| | - Xi Liu
- The Department of Emergency and Pediatrics, Shenzhen Baoan Women's and Children's Hospital, Jinan University, #56, Yulv St., Baoan District, Shenzhen, 518102, Guangdong, China.
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