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Saavedra MJ, Vythinathan C, Basak RB, Dubey S, Kohlhoff S, Desai N. Prolonged Fever in a 3-Year-Old With Sickle Cell Disease. Pediatrics 2024; 153:e2023064274. [PMID: 38591138 DOI: 10.1542/peds.2023-064274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 04/10/2024] Open
Affiliation(s)
- Melina J Saavedra
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, New York
- Department of Pediatrics
| | - Chellapriya Vythinathan
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, New York
- Department of Pediatrics
| | - Ratna B Basak
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, New York
- Department of Pediatrics
- Divisions of Pediatric Hospitalist Medicine
| | - Siddharth Dubey
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, New York
- Department of Pediatrics
- Pediatric Cardiology
| | - Stephan Kohlhoff
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, New York
- Department of Pediatrics
- Pediatric Infectious Diseases
| | - Ninad Desai
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, New York
- Department of Pediatrics
- Pediatric Hematology, New York City Health and Hospitals/Kings County, Brooklyn, New York
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2
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Huang YN, Lin CY, Chi H, Chiu NC, Huang DTN, Chang L, Kung YH, Huang CY. Jaundice-predominant manifestation of Kawasaki disease in children. Front Pediatr 2024; 11:1281909. [PMID: 38264503 PMCID: PMC10803413 DOI: 10.3389/fped.2023.1281909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024] Open
Abstract
Background A jaundice-predominant presentation of Kawasaki disease (KD) is atypical. Methods A total of 12 children with KD with a predominant manifestation of jaundice at MacKay Children's Hospital were reviewed, along with 42 cases reported in the literature since 1990. Results The median age of the 12 patients was 1.85 years (range: 3 months-4 years), and 66.6% were male. All of the patients had elevated liver function at presentation, 50% had hydrops of the gallbladder, and almost 60% had gastrointestinal symptoms and signs. Complete KD was evident in 11 of the 12 patients (91.7%), and two patients (16.7%) had recurrent episodes. All of the patients received intravenous immunoglobulin (IVIG); however, one-third were refractory to treatment. Corticosteroids were used in five (41.7%) of the patients. Three (25%) of the patients had shock, and seven (58.3%) had coronary artery abnormalities, of whom one (8.3%) had persistent coronary artery aneurysm and the others recovered. A review of the 42 cases in the literature showed that the children with a jaundice-predominant presentation of KD had high rates of IVIG-refractory disease (25%), coronary artery abnormalities (25%), shock (13.2%), and corticosteroid treatment (24.2%). Conclusions Children with KD presenting with a jaundice-predominant manifestation are at a higher risk of IVIG-refractory disease, coronary artery abnormalities, and more recurrent episodes. Physicians should be aware of the risk of shock in this population.
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Affiliation(s)
- Ya-Ning Huang
- Department of Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
| | - Hsin Chi
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
| | - Nan-Chang Chiu
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
| | - Daniel Tsung-Ning Huang
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
| | - Lung Chang
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Pediatrics, Tamshui MacKay Memorial Hospital, Taipei, Taiwan
| | - Yen-Hsin Kung
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
- Department of Pediatrics, Tamshui MacKay Memorial Hospital, Taipei, Taiwan
| | - Ching-Ying Huang
- Department of Medicine, MacKay Medicine College, Taipei, Taiwan
- Department of Pediatric Infectious Diseases, MacKay Children’s Hospital, Taipei, Taiwan
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3
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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.
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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
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4
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Miyazawa A, Matsushima T, Sakakibara H, Akahoshi S, Morikawa Y, Koyama Y, Miyata K, Hataya H, Miura M. Clinical implications of gallbladder enlargement in Kawasaki disease. Pediatr Int 2023; 65:e15543. [PMID: 37493267 DOI: 10.1111/ped.15543] [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: 01/22/2023] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Kawasaki disease (KD) presents with gallbladder enlargement (GBE) or hydrops in the acute phase. Although GBE is highly specific to KD, epidemiological data on GBE have not been updated. In this study we evaluated the occurrence rate of GBE in KD and characterized the clinical features of patients who developed GBE. METHODS The present study was a prospective, observational study. The maximum longitudinal area of the gallbladder and the common bile duct diameter in KD patients were measured by ultrasonography at the start of initial intravenous immunoglobulin (IVIG) therapy (day 0) and on days 7, 30, and 60 of therapy. The primary outcome was the complication rate of GBE (z- score ≥2.0) on day 0. The secondary outcome was the association of GBE with cholestasis, unresponsiveness to IVIG, and coronary artery lesions (CAL). RESULTS Gallbladder enlargement occurred in 35% (35/101) of patients on day 0. Cholestasis and severe patients (Kobayashi score [KS] ≥5) were more common in the GBE group (20.6% vs. 1.6%, p = 0.002, and 54.3% vs. 15.2%, p < 0.001, respectively). In patients with a KS of ≤4, the non-responder rate was higher in the GBE group (44% vs. 20%, p = 0.0495) but did not differ in those with a KS of ≥5 (21% vs. 20%, p = 0.95). The rate of CAL occurrence did not differ significantly between the groups (8.6% vs. 6.1%, p = 0.64). CONCLUSIONS Gallbladder enlargement occurred in 35% of KD patients and was associated with cholestasis. Gallbladder enlargement may not only be a diagnostic finding, but also a severity marker in KD patients.
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Affiliation(s)
- Ayako Miyazawa
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Takahiro Matsushima
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroshi Sakakibara
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Shogo Akahoshi
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yoshihiko Morikawa
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yutaro Koyama
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Koichi Miyata
- Department of Pediatrics, School of Medicine, and Rady Children's Hospital, University of California San Diego, La Jolla, California, USA
| | - Hiroshi Hataya
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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5
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Kawasaki Disease with Hepatobiliary Manifestations. Medicina (B Aires) 2022; 58:medicina58121833. [PMID: 36557034 PMCID: PMC9781147 DOI: 10.3390/medicina58121833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives: Kawasaki Disease (KD) incidence has been on the rise globally throughout the years, particularly in the Asia Pacific region. KD can be diagnosed based on several clinical criteria. Due to its systemic inflammatory nature, multi-organ involvement has been observed, making the diagnosis of KD more challenging. Notably, several studies have reported KD patients presenting with hepatobiliary abnormalities. Nonetheless, comprehensive data regarding the hepatobiliary manifestations of KD are limited in Malaysia, justifying a more in-depth study of the disease in this country. Thus, in this article, we aim to discuss KD patients in Malaysia with hepatobiliary manifestations. Materials and Methods: A total of six KD patients with hepatobiliary findings who presented at Hospital Canselor Tuanku Muhriz (HCTM) from 2004 to 2021 were selected and included. Variables including the initial presenting signs and symptoms, clinical progress, laboratory investigations such as liver function test (LFT), and ultrasound findings of hepatobiliary system were reviewed and analyzed. Results: Out of these six KD patients, there were two patients complicated with hepatitis and one patient with gallbladder hydrops. Different clinical features including jaundice (n = 3) and hepatomegaly (n = 4) were also observed. All patients received both aspirin and intravenous immunoglobulin (IVIG) as their first-line treatment and all of them responded well to IVIG. The majority of them (n = 5) had a complete recovery and did not have any cardiovascular and hepatobiliary sequelae. Conclusions: Despite KD mostly being diagnosed with the classical clinical criteria, patients with atypical presentations should always alert physicians of KD as one of the possible differential diagnoses. This study discovered that hepatobiliary manifestations in KD patients were not uncommon. More awareness on the epidemiology, diagnosis, and management of KD patients with hepatobiliary manifestations are required to allow for the initiation of prompt treatment, thus preventing further complications.
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6
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Zhao L, Hua Y, Zhou K. Prominent gallbladder enlargement: Kawasaki disease or other congenital or acquired gallbladder disease? A case report. J Int Med Res 2021; 49:3000605211041507. [PMID: 34496644 PMCID: PMC8442496 DOI: 10.1177/03000605211041507] [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: 11/17/2022] Open
Abstract
Kawasaki disease (KD) is a common systemic vasculitis in childhood that can result in damage to multiple body systems. However, prominent gallbladder (GB) enlargement in the acute stage is especially rare. A 5-year-old boy was admitted to the hospital with an 8-day history of a cervical mass, 7-day history of fever, and 5-day history of abdominal pain and rash. The child was diagnosed with KD. After treatment with high-dose intravenous immunoglobulin therapy (2 g/kg), all clinical manifestations were relieved except the abdominal pain. Enhanced computed tomography showed distinct enlargement of the GB, and a congenital choledochal cyst was strongly suspected. After high-dose glucocorticoid treatment, his obviously enlarged GB returned to normal size in the subacute phase. No abnormality was found during 2 years of follow-up. Prominent GB enlargement may emerge in the acute stage of KD. The enlarged GB can return to normal size within the subacute stage by standard treatment for KD. Proper diagnosis, thorough differential diagnosis, and active anti-inflammatory treatment of KD are crucial to avoid surgery.
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Affiliation(s)
- Liang Zhao
- Department of Paediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China.,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yimin Hua
- Department of Paediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China.,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Paediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,The Cardiac Development and Early Intervention Unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China.,Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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7
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Bhasin A, Lee CK, Shulman S, White AA, Stanley M. An A-Peeling Diagnosis. J Hosp Med 2021; 16:jhm.3567. [PMID: 34328832 DOI: 10.12788/jhm.3567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/07/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Ajay Bhasin
- Department of Medicine, Division of Hospital Medicine, Northwestern Memorial Hospital, Feinberg School of Medicine, Chicago, Illinois
- Department of Pediatrics, Division of Hospital-Based Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Chicago, Illinois
| | - Cheryl K Lee
- Department of Medicine, Division of Hospital Medicine, Northwestern Memorial Hospital, Feinberg School of Medicine, Chicago, Illinois
- Department of Pediatrics, Division of Hospital-Based Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Chicago, Illinois
| | - Stanford Shulman
- Department of Pediatrics, Division of Infectious Diseases, Ann & Robert H Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Chicago, Illinois
| | - Andrew A White
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Marion Stanley
- Department of Medicine, Division of Hospital Medicine, Northwestern Memorial Hospital, Feinberg School of Medicine, Chicago, Illinois
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8
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Affiliation(s)
- Victoria Yellamaty
- University of Queensland, Ochsner Clinical School, New Orleans, LA, USA.,Ochsner Hospital for Children, New Orleans, LA, USA
| | - Russell W Steele
- University of Queensland, Ochsner Clinical School, New Orleans, LA, USA.,Ochsner Hospital for Children, New Orleans, LA, USA.,Tulane University, New Orleans, LA, USA
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9
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Pilania RK, Vignesh P, Sharma A, Gupta K, Singh S. Letter to the editor. J Paediatr Child Health 2020; 56:347-348. [PMID: 32045132 DOI: 10.1111/jpc.14778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 12/30/2019] [Accepted: 01/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Rakesh K Pilania
- Allergy immunology unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pandiarajan Vignesh
- Allergy immunology unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Avinash Sharma
- Allergy immunology unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Allergy immunology unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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10
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Cazzaniga M, Baselli LA, Cimaz R, Guez SS, Pinzani R, Dellepiane RM. SARS-COV-2 Infection and Kawasaki Disease: Case Report of a Hitherto Unrecognized Association. Front Pediatr 2020; 8:398. [PMID: 32719757 PMCID: PMC7347899 DOI: 10.3389/fped.2020.00398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/10/2020] [Indexed: 12/25/2022] Open
Abstract
Coronavirus-associated disease (COVID-19) was firstly reported at the end of 2019. Generally, COVID-19 seems to be a less severe disease in children than in adults. According to the current literature, children account approximately for 2% of diagnosed COVID-19 cases. Northern Italy is one of the geographical areas mainly affected by the ongoing COVID-19 pandemic. We describe a pediatric patient diagnosed and treated for atypical/incomplete Kawasaki Disease (KD) complicated with paralytic ileus, who also resulted positive for SARS-COV-2.
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Affiliation(s)
- Marco Cazzaniga
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lucia Augusta Baselli
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
| | - Sophie Suzanne Guez
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaella Pinzani
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Maria Dellepiane
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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11
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Arslanoglu Aydin E, Demir S, Aydin O, Bilginer Y, Ozen S. Pleural effusion as an atypical presentation of Kawasaki disease: a case report and review of the literature. J Med Case Rep 2019; 13:344. [PMID: 31760956 PMCID: PMC6876070 DOI: 10.1186/s13256-019-2284-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/09/2019] [Indexed: 12/29/2022] Open
Abstract
Background Kawasaki disease is an acute, febrile vasculitis of childhood that affects medium-sized arteries, predominantly the coronary arteries. It is a multisystem disease; therefore, it may present with non-cardiac findings of disease. Case presentation Here, we report the case of 7-year-old Turkish girl who presented with symptoms of fever, chest pain, and vomiting, who was diagnosed as having Kawasaki disease. We also present a literature review on pulmonary involvement due to Kawasaki disease. Conclusion Pediatricians should consider the diagnosis of Kawasaki disease in the presence of pneumonia and pleural effusion that is nonresponsive to antibiotic therapy. This will prevent delay in diagnosis and the adverse consequences of the disease.
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Affiliation(s)
- Elif Arslanoglu Aydin
- Department of Pediatrics, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Selcan Demir
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Orkun Aydin
- Department of Pediatric Emergency, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
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12
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Colomba C, La Placa S, Saporito L, Corsello G, Ciccia F, Medaglia A, Romanin B, Serra N, Di Carlo P, Cascio A. Intestinal Involvement in Kawasaki Disease. J Pediatr 2018; 202:186-193. [PMID: 30029859 DOI: 10.1016/j.jpeds.2018.06.034] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/04/2018] [Accepted: 06/13/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To describe a case of Kawasaki disease with intestinal involvement and to analyze other published reports to define clinical characteristics, diagnostic issues, and therapeutic approaches of gastrointestinal involvement in Kawasaki disease. STUDY DESIGN A computerized search without language restriction was conducted using PubMed and SCOPUS. An article was considered eligible for inclusion in the systematic review if it reported data on patient(s) with intestinal involvement in Kawasaki disease. Our case was also included in the analysis. RESULTS Thirty-three articles reporting 48 cases of Kawasaki disease with intestinal involvement were considered. Fever, abdominal pain, and vomiting were the most frequent symptoms observed and typical Kawasaki disease signs and symptoms appeared after intestinal complaints in all cases. Plain radiographs, ultrasonography, and computed tomography showed pseudo-obstruction as the most frequent sign of gastrointestinal involvement; 25 patients underwent surgery. Cardiac involvement was documented in 21 cases. All but three patients received medical treatment with immunoglobulin intravenous or aspirin. The outcome was good in 28 patients; 7 patients showed persistence of coronary artery abnormalities; 1 patient developed cyanosis, and later, left hand and forefoot gangrene; 3 patients died. CONCLUSIONS The diagnosis and treatment of Kawasaki disease might be delayed if intestinal symptoms appear before the characteristic clinical features of Kawasaki disease, thus, increasing the risk of cardiac complications. Furthermore, patients may undergo unnecessary invasive procedures. Pediatricians and pediatric surgeons, therefore, should consider Kawasaki disease among diagnoses in children with fever, abdominal symptoms, and radiologic findings of pseudo-obstruction.
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Affiliation(s)
- Claudia Colomba
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy.
| | - Simona La Placa
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Laura Saporito
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Francesco Ciccia
- Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy
| | - Alice Medaglia
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Benedetta Romanin
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Nicola Serra
- Department of Pediatrics, School of Medicine, Federico II University, Naples, Italy
| | - Paola Di Carlo
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Antonio Cascio
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
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Pilania RK, Bhattarai D, Singh S. Controversies in diagnosis and management of Kawasaki disease. World J Clin Pediatr 2018; 7:27-35. [PMID: 29456929 PMCID: PMC5803562 DOI: 10.5409/wjcp.v7.i1.27] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/13/2017] [Accepted: 12/28/2017] [Indexed: 02/06/2023] Open
Abstract
Kawasaki disease (KD) is a common medium vessel systemic vasculitis that usually occurs in small children. It has a predilection for the coronary arteries, but other medium sized arteries can also be involved. The etiology of this disorder remains a mystery. Though typical presentation of KD is quite characteristic, it may also present as incomplete or atypical disease in which case the diagnosis can be very challenging. As both incomplete and atypical forms of KD can be associated with serious coronary artery complications, the pediatrician can ill afford to miss these diagnoses. The American Heart Association has enunciated consensus guidelines to facilitate the clinical diagnosis and treatment of this condition. However, there are still several issues that remain controversial. Intravenous immunoglobulin remains the cornerstone of management but several other treatment modalities, especially glucocorticoids, are increasingly finding favour. We review here some of the contemporary issues, and the controversies thereon, pertaining to management of KD.
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Affiliation(s)
- Rakesh Kumar Pilania
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Dharmagat Bhattarai
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Surjit Singh
- Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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