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Sang Y, Luo L, Qiao L. Incomplete Kawasaki disease with muscular weakness and bladder retention: a case report. BMC Pediatr 2024; 24:415. [PMID: 38926640 PMCID: PMC11201324 DOI: 10.1186/s12887-024-04874-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute systemic immune vasculitis affecting multiple organs and systems in children, and is prevalent in children under 5 years of age. Muscular weakness is a rare manifestation of KD, and only 11 pediatric patients with KD combined with muscular weakness have been reported, of which evidence of myositis was found in 2/3 of the patients, and 1/3 could not be explained by myositis, the mechanism of which is still unclear. Cases of KD combined with bladder retention are even more rare, and there has been only 1 case report of KD combined with bladder retention in a child with no previous underlying disease. CASE PRESENTATION We report a 22-month-old Asian child with incomplete Kawasaki disease (IKD) who initially presented with fever and progressive muscular weakness in the lower extremities, followed by the bladder and bowel retention abnormalities and rapid onset of heart failure, respiratory failure and shock. The child developed coronary artery ectasia (CAA) without the main clinical features of KD such as rash, conjunctival congestion, desquamation of the extremity endings, orofacial changes and enlarged lymph nodes in the neck. Creatine kinase and electromyography were normal. Temperature gradually normalized and muscle strength recovered slightly after intravenous immunoglobulin. The child could be helped to walk after 1 week of aspirin combined with steroid therapy. CONCLUSIONS We present the case of a 22-month-old child with IKD. The child began with progressive muscular weakness in the extremities, followed by the bladder and bowel retention abnormalities, and rapidly developed heart failure, respiratory failure, and shock. Despite early failure to detect the disease, the child recovered rapidly and had a favorable prognosis. KD comorbidities with muscular weakness as the main manifestation are uncommon. This is the first case report of IKD combined with both muscular weakness and bladder and bowel retention, which may provide clinicians with diagnostic and therapeutic ideas, as well as a basis for future exploration of the mechanisms of KD combined with muscular weakness or bladder and bowel retention abnormalities.
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Affiliation(s)
- Yating Sang
- Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Lili Luo
- Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China.
| | - Lina Qiao
- Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China.
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, China.
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Huang L, Peng S, Li J, Xie D. Case Report: Lower Limb Muscle Weakness in a Child With Kawasaki Disease. Front Pediatr 2022; 10:893568. [PMID: 35799696 PMCID: PMC9253666 DOI: 10.3389/fped.2022.893568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Kawasaki disease (KD) is a systemic vasculitis that may impact multiple organ systems in children. Myositis is an unusual presentation of KD that presents with muscle weakness. To date, a few pediatric patients with KD and myositis have been reported. Diffuse muscle weakness involving the 4 limbs was the most common presentation in these children. However, isolated lower limb involvement was rarely reported before. Here, we report lower limb muscle weakness in an 18-month-old child with KD. He presented with fever, rash, conjunctival injection, peeling over fingers and toes, and progressive muscle weakness of the lower limbs. Muscle enzymes were normal, but electromyography indicated myositis. The symptom of fever was relieved quickly by intravenous immunoglobulin and aspirin, which were ineffective for myositis. However, lower limb muscle weakness fully recovered 5 days after prednisolone treatment. This rare case might add value to the growing literature exploring the association of KD with myositis.
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Affiliation(s)
- Lilin Huang
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shumei Peng
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jing Li
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Danyu Xie
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
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Lin Y, Wang L, Li A, Zhang H, Shi L. Eyelid ptosis and muscle weakness in a child with Kawasaki disease: a case report. BMC Pediatr 2021; 21:526. [PMID: 34837997 PMCID: PMC8626717 DOI: 10.1186/s12887-021-02979-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/28/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute febrile vasculitis that often occurs in children under 5 years. Ptosis and muscle weakness associated with KD are rarely documented. CASE PRESENTATION We present a case of KD with eyelid ptosis and muscle weakness in a 3-year-old boy. At admission, grade IV and grade III muscle strength were recorded for upper and lower limbs, respectively. Diminished patellar tendon reflex was noted. Laboratory evaluation showed hypokalemia with the serum potassium concentration of 2.62 mmol/L. Intravenous immunoglobulin (IVIG) and aspirin were initiated immediately accompanied with methylprednisolone for adjunctive therapy. Potassium supplement was administered at the same time, which resulted in the correction of hypokalemia on the 2nd day of admission but no improvement in ptosis and muscle weakness. Neostigmine testing, lumber puncture, electromyography, and cerebral and full spine MRI were performed, which, however, did not find evidence for neural and muscle diseases. On the 5th day, the fever was resolved. On the 6th day, eyelid ptosis disappeared. And on the 14th day, the muscle strength and muscle tension returned to normal, patellar tendon reflex could be drawn out normally, and the boy regained full ambulatory ability. CONCLUSIONS KD might affect the neural and muscular systems, and KD complicated with eyelid ptosis and muscle weakness is responsive to the standard anti-inflammatory treatment plus adjunctive corticosteroid therapy.
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Affiliation(s)
- Yao Lin
- Department of Pediatric Cardiology, Children's Hospital, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, China
| | - Lijun Wang
- Department of Pediatric Cardiology, Children's Hospital, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, China
| | - Aijie Li
- Department of Pediatric Cardiology, Children's Hospital, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, China
| | - Hongwei Zhang
- Department of Pediatric Cardiology, Children's Hospital, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, China
| | - Lin Shi
- Department of Pediatric Cardiology, Children's Hospital, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, China.
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Giordano S, Failla MC, Li Cavoli MG, Romano D, Vanella V, Caruso C, Chillura I, Maggio MC. A 7-Year-Old Boy and a 14-Year-Old Girl Initially Diagnosed with Toxic Shock Syndrome and Tested Positive for SARS-CoV-2 Infection, Supporting a Diagnosis of Multisystem Inflammatory Syndrome in Children (MIS-C). AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931570. [PMID: 34635631 PMCID: PMC8522524 DOI: 10.12659/ajcr.931570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) has recently been described in children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This report describes 2 children with MIS-C who were initially diagnosed with toxic shock syndrome but who tested positive for SARS-CoV-2 infection on reverse transcription-polymerase chain reaction, supporting the diagnosis of MIS-C. CASE REPORT Case 1. A 7-year-old boy with fever, cough, and dyspnea was treated with oxygen, intravenous immunoglobulin (IVIG) infusion, and methylprednisolone and showed a worsening of clinical conditions, persistent fever, hypotension, and hematological parameters compatible with macrophage activation syndrome (MAS). Three intravenous boluses of methylprednisolone (30 mg/kg/day) were followed by a progressive resolution. Case 2. A 14-year-old girl with syncope, fever, diarrhea, oliguria, and increased creatinine levels required fluid infusion and correction of electrolyte imbalance. The increase of creatine phosphokinase (CPK), myoglobin, troponin, and creatine kinase-MB (CK-MB) was associated with grade I atrioventricular block and pericardial effusion. The patient showed myositis and severe muscular weakness, with hematological parameters compatible with MIS-C. She started IVIG and 3 intravenous boluses of methylprednisolone. However, bradycardia, tachypnea, severe hypotension, loss of consciousness, oliguria, bilateral ground-glass pneumonia, bilateral pleural, and peritoneal effusion, in the absence of thromboembolism, required treatment with furosemide, albumin, and enoxaparin, and was followed by a prompt resolution. CONCLUSIONS These 2 pediatric cases highlight the importance of SARS-CoV-2 testing in all patients with acute symptoms and signs of infection during the COVID-19 pandemic. As new variants of SARS-CoV-2 emerge, cases of MIS-C can become more prevalent, and pediatricians should be aware of diagnostic and management guidelines.
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Affiliation(s)
- Salvatore Giordano
- U.O.C. of Pediatric Infectious Diseases, Pediatric COVID Center, Children Hospital "G. Di Cristina", ARNAS, Palermo, Italy
| | - Maria Concetta Failla
- U.O.C. of Pediatric Infectious Diseases, Pediatric COVID Center, Children Hospital "G. Di Cristina", ARNAS, Palermo, Italy
| | - Maria Grazia Li Cavoli
- U.O.C. of Pediatric Infectious Diseases, Pediatric COVID Center, Children Hospital "G. Di Cristina", ARNAS, Palermo, Italy
| | - Domenico Romano
- University Department PROMISE "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Veronica Vanella
- University Department PROMISE "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Chiara Caruso
- University Department PROMISE "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Ilenia Chillura
- University Department PROMISE "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Maria Cristina Maggio
- University Department PROMISE "G. D'Alessandro", University of Palermo, Palermo, Italy
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