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Kostara M, Serbis A, Pavlou M, Kotanidou E, Tsabouri S, Vlahos A, Makis A, Siomou E. Unusual Manifestations of Kawasaki Disease in the COVID Era: A Case Series and Review of the Literature. Cureus 2023; 15:e51104. [PMID: 38274908 PMCID: PMC10809307 DOI: 10.7759/cureus.51104] [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] [Accepted: 12/25/2023] [Indexed: 01/27/2024] Open
Abstract
Kawasaki disease (KD) is an acute medium-vessel vasculitis, mainly affecting infants older than six months and children under five years. It predisposes to the development of coronary artery aneurysms and constitutes the leading cause of acquired heart disease in children. Its diagnosis is based on clinical criteria, namely, fever lasting for ≥ five days together with at least four of the five principal clinical features of the disease. Occasionally, children with KD present with fever, but they fulfill only some of the five principal criteria, and this is described as incomplete KD. Furthermore, "atypical" KD is a term that is usually used for cases that appear with rather unusual clinical manifestations, which complicate clinical judgment and may delay diagnosis and treatment. In this case series, we present four cases of KD with rather unusual clinical features: a five-year-old boy with lobar pneumonia, a six-year-old girl with orange-brown chromonychia appearing on the 10th day of the disease, a 2.5-month-old infant with prolonged fever and urinary tract infection, and an 18-month-old infant with refractory KD and high suspicion of multisystem inflammatory syndrome in children (MIS-C). A literature review on the unusual manifestations of atypical KD was performed to identify clinical findings that must alert the clinician to consider this clinical entity.
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Affiliation(s)
- Maria Kostara
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
| | - Anastasios Serbis
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
| | - Maria Pavlou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
| | - Eleni Kotanidou
- Second Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, GRC
| | - Sofia Tsabouri
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
| | - Antonios Vlahos
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
| | - Alexandros Makis
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
| | - Ekaterini Siomou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
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Nabavizadeh SH, Mehdizadegan N, Moeini M, Alyasin S, Esmaeilzadeh H, Askarisarvestani A. Assessing the Association of Kawasaki Disease Symptoms and Echocardiographic Findings. Pediatr Cardiol 2022; 43:816-820. [PMID: 34854940 DOI: 10.1007/s00246-021-02792-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
Kawasaki disease is an acute systemic vasculitis which can cause cardiac involvement among other symptoms. In this study we aimed to assess the relationship between the echocardiographic findings of Kawasaki disease with the clinical and paraclinical findings of the patients. In this cross-sectional study, the symptoms of 307 Kawasaki patients were registered and the association of the symptoms with paraclinical findings and echocardiographic studies was assessed. 190 (61.9%) of the patients were male and 117 (38.1%) were female. 193 patients (62.9%) did not have any abnormalities in their echocardiography, while others showed coronary artery aneurysms, perivascular brightness, coronary artery dilatation, and trivial Mitral Regurgitation in their echocardiography. A significant inverse relationship was seen with echocardiographic findings and age. Thrombocytosis, conjunctivitis, and oral and/or pharyngeal erythema and/or strawberry tongue were associated with higher rates of echocardiographic abnormalities. Echocardiographic abnormalities are associated with younger age, higher platelets, and the existence of conjunctivitis and oral and/or pharyngeal erythema and/or strawberry tongue.
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Affiliation(s)
| | - Nima Mehdizadegan
- Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Moeini
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soheila Alyasin
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Esmaeilzadeh
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Division of Allergy and Clinical Immunology, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Askarisarvestani
- Division of Allergy and Clinical Immunology, Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Pediatrics, Namazee Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Suganuma E, Kambe T, Sato S, Hamamoto M, Kawano Y. A case of Kawasaki disease complicated with retinal vasculitis. Pediatr Int 2019; 61:829-830. [PMID: 31435981 DOI: 10.1111/ped.13938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/17/2019] [Accepted: 05/15/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Eisuke Suganuma
- Divisions of, Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Tomoka Kambe
- Division of, Ophthalmology, Saitama Children's Medical Center, Saitama, Japan
| | - Satoshi Sato
- Divisions of, Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Manabu Hamamoto
- Division of, Emergency and Critical Care Medicine, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Kawano
- Divisions of, Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
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Gao Y, Zhang Y, Lu F, Wang X, Zhang M. Rare ocular manifestations in an 11-year-old girl with incomplete Kawasaki disease: A case report. Medicine (Baltimore) 2018; 97:e10974. [PMID: 29851850 PMCID: PMC6392708 DOI: 10.1097/md.0000000000010974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Kawasaki disease is a necrotizing vasculitis featuring fever, erythema, conjunctivitis, and lymphadenopathy. Ocular manifestations in Kawasaki disease are commonly limited to anterior segment, posterior segment lesions are rarely reported. CASE PRESENTATION We report a unique case of ocular manifestations in an 11-year-old girl with incomplete Kawasaki disease. An 11-year-old Asian girl presented with severe enophthalmos, retinitis, retinal detachment, and choroidal detachment secondary to an unexplained fever for 10 days. CONCLUSION To the best of our knowledge, this is the first documented case of incomplete Kawasaki disease with severe posterior segment lesions. The local use of dexamethasone in the eye was effective in our patient. Surgical intervention might not be necessary even though the initial symptoms could be devastating. The eye should be monitoring the eye routinely in patients with Kawasaki disease.
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Affiliation(s)
- Yunxia Gao
- Department of Ophthalmology, Sichuan University West China Hospital, Chengdu, Sichuan
| | - Yifan Zhang
- Sichuan University West China School of Medicine, China
| | - Fang Lu
- Department of Ophthalmology, Sichuan University West China Hospital, Chengdu, Sichuan
| | - Xiaoyue Wang
- Department of Ophthalmology, Sichuan University West China Hospital, Chengdu, Sichuan
| | - Ming Zhang
- Department of Ophthalmology, Sichuan University West China Hospital, Chengdu, Sichuan
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Greco A, De Virgilio A, Rizzo MI, Tombolini M, Gallo A, Fusconi M, Ruoppolo G, Pagliuca G, Martellucci S, de Vincentiis M. Kawasaki disease: An evolving paradigm. Autoimmun Rev 2015; 14:703-9. [DOI: 10.1016/j.autrev.2015.04.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/02/2015] [Indexed: 12/22/2022]
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Rodríguez-Lozano A, Juárez-Echenique JC, Rivas-Larrauri F, Gámez-González LB, Yamazaki-Nakashimada M. VI nerve palsy after intravenous immunoglobulin in Kawasaki disease. Allergol Immunopathol (Madr) 2014; 42:82-3. [PMID: 23340202 DOI: 10.1016/j.aller.2012.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 08/04/2012] [Accepted: 08/28/2012] [Indexed: 11/16/2022]
Affiliation(s)
- A Rodríguez-Lozano
- Clinical Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | - F Rivas-Larrauri
- Clinical Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - L B Gámez-González
- Clinical Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
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Palejwala NV, Yeh S, Angeles-Han ST. Current perspectives on ophthalmic manifestations of childhood rheumatic diseases. Curr Rheumatol Rep 2013; 15:341. [PMID: 23686303 DOI: 10.1007/s11926-013-0341-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Inflammatory eye diseases are an important manifestation of many pediatric rheumatologic conditions. Early screening and diagnosis are imperative as these illnesses can not only result in significant visual morbidity but are also an indicator of systemic inflammation. Time to presentation of ocular inflammation varies significantly and can range from many years prior to the onset of systemic symptoms to well after the diagnosis of the rheumatologic disorder. Due to this variability in presentation, careful monitoring by an ophthalmologist is vital to preventing ocular complications and preserving vision. Both local and systemic immunosuppressive medications have been effective in the management of ocular disease. In this review, we will focus on the known ophthalmologic manifestations of common pediatric rheumatologic diseases and discuss recent advances in therapeutic considerations for these conditions.
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Affiliation(s)
- Neal V Palejwala
- Section of Vitreoretinal Surgery, Department of Ophthalmology, Emory University School of Medicine, 1365B Clifton Rd. NE, Atlanta, GA 30322, USA.
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Hu-Torres S, Foster CS. Disease of the Year: Juvenile Idiopathic Arthritis—Differential Diagnosis. Ocul Immunol Inflamm 2013; 22:42-55. [DOI: 10.3109/09273948.2013.835430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yim D, Curtis N, Cheung M, Burgner D. An update on Kawasaki disease II: clinical features, diagnosis, treatment and outcomes. J Paediatr Child Health 2013; 49:614-23. [PMID: 23647873 DOI: 10.1111/jpc.12221] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2012] [Indexed: 01/30/2023]
Abstract
This is the second of two updates on Kawasaki disease. The first review focused on epidemiology and aetio-pathogenesis. Here, we review the clinical features and diagnosis of Kawasaki disease, as well as recent evidence on treatment, follow-up and cardiovascular outcomes.
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Affiliation(s)
- Deane Yim
- Department of Cardiology, The University of Melbourne, Melbourne, Victoria, Australia
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Crystalline-like keratopathy after intravenous immunoglobulin therapy with incomplete kawasaki disease: case report and literature review. Case Rep Ophthalmol Med 2013; 2013:621952. [PMID: 23607016 PMCID: PMC3625593 DOI: 10.1155/2013/621952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/11/2013] [Indexed: 11/18/2022] Open
Abstract
A 7-year-old girl had presented with high body temperature and joint pain which continued for 3 days. Because of the prolonged history of unexplained fever, rash, bilateral nonpurulent conjunctival injection, oropharyngeal erythema, strawberry tongue, and extreme of age, incomplete Kawasaki disease was considered and started on an intravenous immunoglobulin infusion. Six days after this treatment, patient was referred to eye clinic with decreased vision and photophobia. Visual acuity was reduced to 20/40 in both eyes. Slit-lamp examination revealed bilateral diffuse corneal punctate epitheliopathy and anterior stromal haze. Corneal epitheliopathy seemed like crystal deposits. One day after presentation, mild anterior uveitis was added to clinical picture. All ocular findings disappeared in one week with topical steroid and unpreserved artificial tear drops. We present a case who was diagnosed as incomplete Kawasaki disease along with bilateral diffuse crystalline-like keratopathy. We supposed that unusual ocular presentation may be associated with intravenous immunoglobulin treatment.
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Denniston AK, Gayed M, Carruthers D, Gordon C, Murray PI. Rheumatic Disease. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Macular oedema in Kawasaki syndrome. Graefes Arch Clin Exp Ophthalmol 2012; 250:1101-4. [DOI: 10.1007/s00417-011-1914-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 12/11/2011] [Accepted: 12/19/2011] [Indexed: 10/14/2022] Open
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Alves NRDM, de Magalhães CMR, Almeida RDFR, dos Santos RCR, Gandolfi L, Pratesi R. Prospective study of Kawasaki disease complications: review of 115 cases. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1016/s0104-4230(11)70062-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Alves NRDM, de Magalhães CMR, Almeida RDFR, dos Santos RCR, Gandolfi L, Pratesi R. Estudo prospectivo das complicações da Doença de Kawasaki: análise de 115 casos. Rev Assoc Med Bras (1992) 2011. [DOI: 10.1590/s0104-42302011000300012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Inflammatory Bowel Disease and Other Systemic Inflammatory Diseases. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00068-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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