Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Two cases of Kawasaki disease following pneumonia

폐렴에 속발한 가와사끼병 2예

  • Kim, Hyun Jung (Departments of Pediatrics, College of Medicine, Eulji University) ;
  • Lee, Soo Jin (Departments of Pediatrics, College of Medicine, Eulji University)
  • 김현정 (을지대학교 의과대학 소아과학교실) ;
  • 이수진 (을지대학교 의과대학 소아과학교실)
  • Received : 2008.12.03
  • Accepted : 2009.03.13
  • Published : 2009.05.15
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Abstract

Kawasaki disease (KD) causes multisystemic vasculitis but rarely manifests with pulmonary symptoms. As its etiology is still unknown, there are no specific diagnostic tools available, and KD can be diagnosed only by the symptom pattern. The presence of unusual clinical manifestations often leads to delayed diagnosis. Here, we report two cases of KD with an initial presentation of pneumonia. KD should be consideration when there is a prolonged inflammatory reaction and progressive pneumonia unresponsive to antibiotics.

가와사끼병은 전신성 혈관염을 일으키며 드물게 폐렴 등 호흡기 질환의 임상 양상으로 발현될 수 있다. 가와사끼병은 아직 원인이 밝혀지지 않아 진단을 위한 검사 소견이 없고 전형적인 임상 양상에 의해 진단되어지므로 비전형적 임상 양상으로 나타날 경우 그 진단이 늦어질 수 있다. 항생제 치료에도 불구하고 폐렴이 악화되며 염증 반응이 증가되는 경우 가와사끼병을 의심하는 것이 중요하다. 저자들은 폐렴으로 발현된 가와사끼병 2예를 경험하였기에 보고하는 바이다.

Keywords

References

  1. Uziel Y, Hashkes PJ, Kassem E, Gottesman G, Wolach B. "Unresolving pneumonia" as the main manifestation of atypical Kawasaki disease. Arch Dis Child 2003;88:940-2 https://doi.org/10.1136/adc.88.10.940
  2. Kim JY, Kwon JH, Kim KH, Yu JH, Hong YM. Chest X-ray findings and serum tumor necrosis factor-α levels in patients with Kawasaki disease. Korean J Pediatr 2005;48:534- 8
  3. Rowley AH. Incomplete (atypical) Kawasaki disease. Pediatr Infect Dis J 2002;21:563-5 https://doi.org/10.1097/00006454-200206000-00015
  4. Amano S, Hazama F, Kubagawa H, Tasaka K, Haebara H, Hamashima Y. General pathology of Kawasaki disease on the morphological alterations corresponding to the clinical manifestation. Acta Pathol Jpn 1980;30:681-94
  5. Burns JC, Wiggins JW Jr, Toews WH, Newburger JW, Leung DY, Wilson H, et al. Clinical spectrum of Kawasaki disease in infants younger than 6 months of age. J Pediatr 1986;109:759-63 https://doi.org/10.1016/S0022-3476(86)80689-8
  6. Sengler C, Gaedicke G, Wahn U, Keitzer R. Pulmonary symptoms in Kawasaki disease. Pediatr Infect Dis J 2004;23: 782-4 https://doi.org/10.1097/01.inf.0000134313.86697.20
  7. Umezawa T, Saji T, Mtsuo N, Odagirl K. Chest X-ray findings in the acute phase of Kawasaki disease. Pediatr Radiol 1989;20:48-51 https://doi.org/10.1007/BF02010633
  8. Yasukawa K, Terai M, Shulman ST, Toyozaki T, Yajima S, Kohno Y, et al. Systemic production of vascular endothelial growth factor and fms-like growth tyrosine kinase-1 receptor in acute Kawasaki disease. Circulation 2002;105:766-9 https://doi.org/10.1161/hc0602.103396
  9. Managoli S, Chaturvedi P. Kawasaki disease with coronary artery aneurysms and symptomatic pneumonia. Indian Pediatr 2003;40:1106-7
  10. Yavuz T, Nisli K, Yilmaz C, Dindar A. Large pleural effusion necessitates chest tube drainage in a patient with Kawasaki disease. J Paediatr Child Health 2007;43:191-2 https://doi.org/10.1111/j.1440-1754.2007.01043.x
  11. Voynow JA, Schanberg L, Sporn T, Kredich D. Pulmonary complications associated with Kawasaki disease. J Pediatr 2002;140:786-7 https://doi.org/10.1067/mpd.2002.pd124772
  12. Abe J, Kotzin BL, Jujo K, Melish ME, Glode MP, Kohsaka T, et al. Selective expansion of T cells expressing T-cell receptor variable regions Vβ2 and Vβ8 in Kawasaki disease. Proc Natl Acad Sci USA 1992;89:4066-70 https://doi.org/10.1073/pnas.89.9.4066
  13. Curtis N, Zheng R, Lamb JR, Levin M. Evidence for a superantigen mediated process in Kawasaki disease. Arch Dis Child 1995;72:308-11 https://doi.org/10.1136/adc.72.4.308
  14. Leen C, Ling S. Mycoplasma infection and Kawasaki disease. Arch Dis Child 1996;75:266-7
  15. Treadwell TA, Maddox RA, Holman RC, Investigation of Kawasaki syndrome risk factors in Colorado. Pediatr Infect Dis J 2002;21:976-8 https://doi.org/10.1097/00006454-200210000-00018
  16. Bell DM, Brink EW, Nitzkin JL, Hall CB, Wulff H, Berkowitz ID, et al. Kawasaki syndrome: description of two outbreaks in the Unitied States. N Eng J Med 1981;304:1568-75 https://doi.org/10.1056/NEJM198106253042603
  17. Dean AG, Melish ME, Hicks R, Palumbo NE. An epidemic of Kawasaki syndrome in Hawaii. J Pediatr 1982;100:552-7 https://doi.org/10.1016/S0022-3476(82)80751-8
  18. Rowley AH, Baker SC, Shulman ST, Garcia FL, Guzman- Cottrill JA, Chou P, et al. Detection of antigen in bronchial epithelium and macrophages in acute Kawasaki disease by use of synthetic antibody. J Infect Dis 2004;190:856-65 https://doi.org/10.1086/422648
  19. Shike H, Shimizu C, Kanegaye JT, Foley JL, Schnurr DP, Wold LJ, et al. Adenovirus, adenovirus-associated virus and Kawasaki disease. Pediatr Infect Dis J 2005;24:1011-4 https://doi.org/10.1097/01.inf.0000183769.31951.1e
  20. Rowley AH, Shulman ST, Mask CA. IgA plasma cell infiltration of proximal respiratory tract, pancreas, kidney, and coronary artery in acute Kawasaki disease. J Infect Dis 2000;182:1183-91 https://doi.org/10.1086/315832

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