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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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Lee W, Cheah CS, Suhaini SA, Azidin AH, Khoo MS, Ismail NAS, Ali A. Clinical Manifestations and Laboratory Findings of Kawasaki Disease: Beyond the Classic Diagnostic Features. Medicina (B Aires) 2022; 58:medicina58060734. [PMID: 35743997 PMCID: PMC9227912 DOI: 10.3390/medicina58060734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
Kawasaki disease (KD) has shown a marked increase in trend over the globe, especially within the last two decades. Kawasaki disease is often seen in the paediatric population below five years old, while it is rare for those who are beyond that age. Up to this date, no exact causes has been identified although KD was found more than half a century ago. The underlying pathogenesis of the disease is still unelucidated, and researchers are trying to unlock the mystery of KD. To further complicate the diagnosis and the prompt management, a specific biomarker for the diagnosis of KD is yet to be discovered, making it hard to differentiate between KD and other diseases with a similar presentation. Nonetheless, since its discovery, clinicians and scientists alike had known more about the different clinical aspects of typical KD. Thus, this article intends to revisit and review the various clinical manifestations and laboratory characteristics of KD in order to guide the diagnosis of KD.
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Affiliation(s)
- Wendy Lee
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Chooi San Cheah
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Siti Aisyah Suhaini
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Abdullah Harith Azidin
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
| | - Mohammad Shukri Khoo
- Department of Pediatric, Hospital Wanita dan Kanak Kanak Sabah, Kota Kinabalu 88996, Malaysia;
| | - Noor Akmal Shareela Ismail
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia;
| | - Adli Ali
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (W.L.); (C.S.C.); (S.A.S.); (A.H.A.)
- Correspondence: ; Tel.: +603-91748510
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Huijuan K, Yaping D, Bo W, Miao H, Guanghui Q, Wenhua Y. Combined IFN-β and PLT Detection Can Identify Kawasaki Disease Efficiently. Front Pediatr 2021; 9:624818. [PMID: 33968843 PMCID: PMC8100027 DOI: 10.3389/fped.2021.624818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/22/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: To evaluate the value of combined interferon β (IFN-β) and platelet (PLT) detection for Kawasaki disease (KD) identification. Methods: Forty-four children who were newly diagnosed with KD were selected as the KD group. They were divided into acute phase of KD and subacute phase of KD. They were also separated into groups with and without coronary artery disease (CAD) (CAD+ and CAD-, respectively). Meanwhile, 44 children hospitalized with febrile disease and 44 healthy children were selected as a febrile control group and normal control group, whom were attended to at Children's Hospital of Soochow University at the same time. We detected the concentration of IFN-β and PLT of peripheral blood serum for all three groups and analyzed the difference. Results: At acute and subacute phases of KD, both IFN-β and PLT are higher than both the febrile control group and healthy control group, especially at subacute phase; the difference between groups was statistically significant, P < 0.05. Receiver operating characteristic (ROC) curve showed that the areas under the ROC curve (AUCs) of IFN-β and PLT at acute phase of KD were 0.81 and 0.72, respectively; the sensitivity and specificity were 97.22 and 63.64%, and 57.89 and 73.86%, respectively. The AUCs of combined IFN-β and PLT were 0.81 at acute phase and 0.96 at subacute phase of KD, with sensitivity and specificity of 97.22 and 55.26%, and 86.36 and 100%, respectively. The cutoff value of combined IFN-β and PLT detection was IFN-β = 3.51 pg/ml and PLT = 303 × 109/L at acute phase of KD, IFN-β = 4.21 pg/ml and PLT = 368 × 109/L at subacute phase from plot vs. criterion values. However, there are no significant differences between the CAD- group and the CAD+ group for combined IFN-β and PLT, both P > 0.5, neither at acute nor at subacute phase of KD. Conclusion: Combined IFN-β and PLT detection is an efficient biomarker for KD identification. The cutoff values are IFN-β = 3.51 pg/ml and PLT = 303 × 109/L at acute phase of KD and IFN-β = 4.21 pg/ml and PLT = 368 × 109/L at subacute phase.
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Affiliation(s)
- Kan Huijuan
- Department of Cardiology, Children's Hospital Soochow University, Suzhou, China.,Department of Pediatric, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Dong Yaping
- Department of Cardiology, Children's Hospital Soochow University, Suzhou, China
| | - Wang Bo
- Department of Cardiology, Children's Hospital Soochow University, Suzhou, China
| | - Hou Miao
- Department of Cardiology, Children's Hospital Soochow University, Suzhou, China
| | - Qian Guanghui
- Department of Cardiology, Children's Hospital Soochow University, Suzhou, China
| | - Yan Wenhua
- Department of Cardiology, Children's Hospital Soochow University, Suzhou, China
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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 FF, Liu HH, Qiu Z, Wang JJ, Samadli S, Wu Y, Wu YF, Xu Y, Luo HH, Chen WX, Zhang DD, Hu P. Clinical observation of noncoronary cardiac abnormalities in Chinese children with Kawasaki disease. Eur J Clin Invest 2020; 50:e13210. [PMID: 32061097 DOI: 10.1111/eci.13210] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/05/2020] [Accepted: 02/01/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is an acute, self-limited vasculitis. Coronary artery aneurysm (CAA) serves as a major contributor to the long-term prognosis of KD. In addition, acute KD usually also leads to several kinds of noncoronary cardiac abnormalities (NCA) involving the pericardium, myocardium and endocardium. MATERIALS AND METHODS A total of 142 Chinese children with KD were recruited from July 2015 to April 2018. Blood samples were collected at 24 hours pre-intravenous immunoglobulin (IVIG) therapy. Several inflammatory mediators and biomarkers for acute myocardial infarction were detected. Echocardiography and electrocardiography (ECG) were performed. RESULTS Plasma white blood cell counts (WBC) were significantly increased in patients with IVIG-nonresponsive KD when compared with their IVIG-responsive counterparts. A total of 106 children (74.65%) suffered from NCA, including 8 patients (5.63%) with pericardial effusion, 23 patients (16.20%) with acute myocarditis, 101 patients (71.13%) with valvular regurgitation and 8 patients (5.63%) with abnormal ECG. No significant differences were observed in the distribution of clinical classification and the response to IVIG therapy regardless of NCA exhibited or not. CONCLUSIONS Noncoronary cardiac abnormalities is almost universal in acute KD and mainly manifests as valvular regurgitation. However, it has no influence on clinical classification and the response to IVIG therapy.
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Affiliation(s)
- Fei Fei Liu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hui Hui Liu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhen Qiu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jing Jing Wang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Sama Samadli
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yue Wu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yang Fang Wu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yao Xu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huang Huang Luo
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Xia Chen
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dong Dong Zhang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peng Hu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Samadli S, Liu FF, Mammadov G, Wang JJ, Liu HH, Wu YF, Luo HH, Wu Y, Chen WX, Zhang DD, Wei W, Hu P. The time option of IVIG treatment is associated with therapeutic responsiveness and coronary artery abnormalities but not with clinical classification in the acute episode of Kawasaki disease. Pediatr Rheumatol Online J 2019; 17:53. [PMID: 31366406 PMCID: PMC6668082 DOI: 10.1186/s12969-019-0352-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/10/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In the last decade, incomplete Kawasaki disease (KD), intravenous immunoglobulin (IVIG) non-response and coronary artery abnormalities (CAA) have experienced the increasing trends in China. In addition, the enhancement of pediatricians' awareness may also raise the diagnostic rate of incomplete KD and stimulate more aggressive initial therapy in the acute episode of KD. Given this background, we hypothesize that the time option of IVIG treatment should be in parallel with peak time of systemic inflammation; either earlier or later IVIG treatment may affect the clinical classification, therapeutic responsiveness and CAA occurrence in KD patients. Therefore, the major objective of the present study is to identify whether the time option of IVIG treatment could be associated with the clinical classification, therapeutic responsiveness and CAA occurrence in the acute episode of KD. MATERIALS AND METHODS A total of 153 children with KD were recruited between July 2015 and May 2018. All patients received the standard therapy of KD, including a single infusion of IVIG (2 g/kg) and aspirin (30-50 mg/kg/d). Blood samples were collected from all subjects within 24 h pre-IVIG treatment, respectively. Echocardiography was performed during the period from 2 days to 14 days after IVIG treatment. RESULTS (1) The clinical classification presented no significant heterogenicity among different treatment time (x2 = 1.59, p > 0.05) (2) Eleven KD patients resisted to IVIG treatment and 7 of them (63.60%) received the initial IVIG dose on day 5 and 6. (3) The distribution of CAA onset was subjected to a significant difference according to timing option of IVIG treatment (x2 = 11.94, p < 0.05). CONCLUSIONS The time option of IVIG treatment is associated with therapeutic responsiveness and CAA but not with clinical classification in the acute episode of KD.
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Affiliation(s)
- Sama Samadli
- Department of Pediatric, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022 People’s Republic of China
| | - Fei Fei Liu
- Department of Pediatric, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022 People’s Republic of China
| | - Goshgar Mammadov
- Department of Pediatric, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022 People’s Republic of China
| | - Jing Jing Wang
- Department of Pediatric, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022 People’s Republic of China
| | - Hui Hui Liu
- Department of Pediatric, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022 People’s Republic of China
| | - Yang Fang Wu
- Department of Pediatric, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022 People’s Republic of China
| | - Huang Huang Luo
- Department of Pediatric, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022 People’s Republic of China
| | - Yue Wu
- Department of Pediatric, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022 People’s Republic of China
| | - Wei Xia Chen
- Department of Pediatric, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022 People’s Republic of China
| | - Dong Dong Zhang
- Department of Pediatric, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022 People’s Republic of China
| | - Wei Wei
- Department of Pediatric, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022 People’s Republic of China
| | - Peng Hu
- Department of Pediatric, The First Affiliated Hospital of Anhui Medical University, No. 218 Ji-Xi Road, Hefei, 230022 People’s Republic of China
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Spatiotemporal Analysis and Epidemiology of Kawasaki Disease in Western New York: A 16-Year Review of Cases Presenting to a Single Tertiary Care Center. Pediatr Infect Dis J 2019; 38:582-588. [PMID: 30418354 DOI: 10.1097/inf.0000000000002239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kawasaki disease (KD) is one of the leading causes of acquired heart disease in children in developed nations. Epidemiologic evidence suggests that KD is related to an infectious agent; however, the cause remains unknown. Yearly incidence in Japan has been steadily increasing, but few long-term databases of KD cases from North America have been reviewed. METHODS We reviewed the epidemiology of local cases over a 16-year period to study incidence with time and temporal and geographic clustering of cases in a representative cohort in North America. RESULTS The yearly incidence in cases per population <5 years old per 100,000 was 20.2 and 15.9, using International Classification of Disease, ninth revision and detailed chart review, respectively. Using International Classification of Disease, ninth revision alone overestimates our incidence by 27%. We show a distinct seasonality of cases with winter predominance. Applying Kulldorff's spatial scan statistic revealed no significant clustering of cases with either purely spatial or space-time analyses. On purely nonconstrained temporal SaTScan analysis, there was a significant clustering of cases in a 67- to 68-week period in 2000-2001. CONCLUSIONS Our analysis reveals an apparent outbreak of KD in our region in 2000-2001. In contrast to Japan, for the last 14 years, the incidence in our region has been stable.
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Gamez-Gonzalez LB, Hamada H, Llamas-Guillen BA, Ruiz-Fernandez M, Yamazaki-Nakashimada M. BCG and Kawasaki disease in Mexico and Japan. Hum Vaccin Immunother 2017; 13:1091-1093. [PMID: 28281896 DOI: 10.1080/21645515.2016.1267083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Dr. Tomisaku Kawasaki was the first to describe BCG reactivation in Kawasaki Disease (KD), and this sign is present in about 30-50% of KD patients. It is a very specific early sign of the disease and although it has been recognized for decades, its pathophysiology continues to be an enigma. Recently, Yamada et al. reported a severe BCG reaction with tuberculid in 2 Japanese KD patients. We present 2 cases with KD and severe BCG reaction, one from Japan and the other from Mexico and review the policies of administration of BCG in both countries. The BCG vaccine has a worldwide coverage of 88%. Differences in BCG strains and methods of administration may influence BCG reactions in KD. The BCG reaction in the inoculation site may represent the most useful sign in KD.
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Affiliation(s)
- Luisa Berenise Gamez-Gonzalez
- a Department of Allergy and Clinical Immunology , Hospital Infantil de Especialidades de Chihuahua , Chihuahua , Mexico
| | - Hiromichi Hamada
- b Department of Pediatrics , Yachiyo Medical Center, Tokyo Women's Medical University , Yachiyo , Chiba , Japan
| | | | - Miguel Ruiz-Fernandez
- c Department of Allergy and Immunology , Hospital del Niño y Adolescente Morelense , Cuernavaca Morelos , Mexico
| | - Marco Yamazaki-Nakashimada
- d Department of Clinical Immunology , Instituto Nacional de Pediatría, Insurgentes Cuicuilco Coyoacan , Mexico City , Mexico
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Petrarca L, Nenna R, Versacci P, Frassanito A, Cangiano G, Nicolai A, Scalercio F, Russo LL, Papoff P, Moretti C, Midulla F. Difficult diagnosis of atypical kawasaki disease in an infant younger than six months: a case report. Ital J Pediatr 2017; 43:30. [PMID: 28274249 PMCID: PMC5341178 DOI: 10.1186/s13052-017-0345-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/25/2017] [Indexed: 12/18/2022] Open
Abstract
Background Kawasaki disease (KD) is an acute inflammatory vasculitis of unknown origin. Case presentation We report the case of a 5-month-old child with an atypical form of KD, characterized by undulating symptoms, who developed an aneurysm of the right coronary artery and an ectasia of the left anterior descending coronary artery. Conclusion This case report underlines the difficulties in recognizing incomplete forms of the illness in young infants, who are at higher risk of cardiac complications.
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Affiliation(s)
- L Petrarca
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - R Nenna
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - P Versacci
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - A Frassanito
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - G Cangiano
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - A Nicolai
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - F Scalercio
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - L Lo Russo
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - P Papoff
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - C Moretti
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy
| | - F Midulla
- Department of Pediatrics, "Sapienza" University of Rome, V.le Regina Elena 324, 00161, Rome, Italy.
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Kibata T, Suzuki Y, Hasegawa S, Matsushige T, Kusuda T, Hoshide M, Takahashi K, Okada S, Wakiguchi H, Moriwake T, Uchida M, Ohbuchi N, Iwai T, Hasegawa M, Ichihara K, Yashiro M, Makino N, Nakamura Y, Ohga S. Coronary artery lesions and the increasing incidence of Kawasaki disease resistant to initial immunoglobulin. Int J Cardiol 2016; 214:209-15. [PMID: 27070994 DOI: 10.1016/j.ijcard.2016.03.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/12/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUNDS Kawasaki disease (KD) is a systemic vasculitis of childhood involving coronary arteries. Treatment for intractable cases at a higher risk of cardiac sequelae remains controversial. METHODS Clinical outcomes of KD patients diagnosed in Yamaguchi prefecture, Japan between 2003 and 2014 were analyzed using the medical records from all 14 hospitals covering the prefecture. The study included 1487 patients (male:female, 873:614; median age at diagnosis, 24months). RESULTS The proportion of initial intravenous immunoglobulin (IVIG)-resistant patients increased from 7% to 23% during this decade, although no patients died. Twenty-four patients developed coronary artery lesions (CALs) over one month after the KD onset. The incidence of CAL in patients who received corticosteroid during the disease course (10/37; 27.0%) was higher than that in those who did not (14/1450; 0.97%, p=2.0×10(-35)). Nine patients who responded to initial IVIG plus corticosteroids had no CAL. Conversely, IVIG-resistant patients with alternate corticosteroid therapy more frequently developed CAL than those without it (10/28; 35.7% vs. 5/194; 2.6%, p=8.9×10(-10)). Multivariate analyses indicated corticosteroid therapy (p<0.0001), hyperbilirubinemia (p=0.0010), and a longer number of days before treatment (p=0.0005) as risk factors associated with CAL over a month after onset. The odds ratio of corticosteroid use increased from 18.3 to 43.5 if the cases were limited to initial IVIG non-responders and corticosteroid free-IVIG responders. CONCLUSIONS IVIG-failure has recently increased. The incidence of CAL increased in intractable cases with prolonged corticosteroid use. Corticosteroid may not be alternate choice for IVIG-failure to reduce the risk of cardiac sequelae.
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Affiliation(s)
- Tetsuhiro Kibata
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yasuo Suzuki
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan.
| | - Takeshi Matsushige
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takeshi Kusuda
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Madoka Hoshide
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kazumasa Takahashi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroyuki Wakiguchi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tadashi Moriwake
- Division of Pediatrics, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Masashi Uchida
- Division of Pediatrics, JCHO Tokuyama Central Hospital, Shunan, Japan
| | - Noriko Ohbuchi
- Division of Pediatrics, Yamaguchi Red Cross Hospital, Yamaguchi, Japan
| | - Takashi Iwai
- Division of Pediatrics, Yamaguchi-ken Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | | | - Kiyoshi Ichihara
- Department of Laboratory Sciences, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Mayumi Yashiro
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Nobuko Makino
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
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