Pediatric Infection and Vaccine

  • 제22권1호
  • /
  • Pages.40-44
  • /
  • 2015
  • /
  • 2384-1079(pISSN)
  • /
  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
권호 표지
DOI QR코드

DOI QR Code

뇌척수액세포증가증과 경막외 삼출액이 동반된 비정형 가와사키병 1례

Incomplete Kawasaki Disease in a 5-Month-Old Girl Associated with Cerebrospinal Fluid Pleocytosis and Epidural Fluid Collection

  • 김정옥 (제주대학교병원 소아청소년과) ;
  • 이현주 (제주대학교 의학전문대학원) ;
  • 한경희 (제주대학교병원 소아청소년과)
  • Kim, Jung-Ok (Department of Pediatrics, Jeju National University Hospital) ;
  • Lee, Hyeon Ju (Jeju National University School of Medicine) ;
  • Han, Kyoung Hee (Department of Pediatrics, Jeju National University Hospital)
  • 투고 : 2014.10.14
  • 심사 : 2014.10.26
  • 발행 : 2015.04.25
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

비정형 가와사키병은 가와사키병의 진단기준을 충족하지 않는 경우를 말하며, 주로 6개월 미만의 영아에게서 발현하는 경우가 많다. 비정형 가와사키병의 임상소견은 뇌수막염과 같은 감염질환과 비슷할 때가 있어서, 이러한 경우 임상적으로 비정형 가와사키병을 감염질환과 감별하기 어려울 때가 많다. 또한 가와사키병과 연관되어 보고된 신경계 이상은 무균수막염, 경막하삼출, 안면신경마비, 뇌경색증, 뇌병증, 뇌자기공명영상의 가역적 뇌량팽대 변화 등이 있다. 본 저자들은 뇌척수액세포증가증과 경막외삼출액이 동반된 비정형 가와사키병으로 진단된 5개월 여아에 대해 보고하는 바이다. 환자의 심장초음파검사에서 관상동맥이 늘어나 있었고, 추적관찰에서 경막외 삼출액과 관상동맥 합병증이 모두 회복되었으며 생후 12개월에 발달이정표는 정상이었다.

Cases of incomplete Kawasaki disease (KD), wherein the patient does not fulfill the full diagnostic criteria for KD, are often detected in infants younger than 6 months of age. The clinical manifestations in infants with incomplete KD may resemble other infectious diseases, including meningitis. For this reason, clinicians may have difficulty differentiating incomplete KD from other infectious diseases in this population. Various neurological features are associated with KD, including aseptic meningitis, subdural effusion, facial nerve palsy, cerebral infarction, encephalopathy, and reversible corpus callosum splenial lesions on magnetic resonance imaging. We report a case of a 5-month-old girl with incomplete KD, associated with cerebrospinal fluid pleocytosis and an epidural fluid collection. Echocardiography indicated dilatation of the main coronary arteries. The girl made a complete recovery, with resolution of both the epidural fluid collection and coronary artery aneurysms. In this case, the child is well, and showed normal developmental milestones at the 7-month follow-up.

키워드

참고문헌

  1. Burns JC, Glode MP. Kawasaki syndrome. Lancet 2004;364:533-44. https://doi.org/10.1016/S0140-6736(04)16814-1
  2. Rowley AH, Gonzalez-Crussi F, Gidding SS, Duffy CE, Shulman ST. Incomplete Kawasaki disease with coronary artery involvement. J Pediatr 1987;110:409-13. https://doi.org/10.1016/S0022-3476(87)80503-6
  3. Yeom JS, Woo HO, Park JS, Park ES, Seo JH, Youn HS. Kawasaki disease in infants. Korean J Pediatr 2013;56:377-82. https://doi.org/10.3345/kjp.2013.56.9.377
  4. Cabral M, Correia P, Brito MJ, Conde M, Carreiro H. Kawasaki disease in a young infant: diagnostic challenges. Acta Reumatol Port 2011;36:304-8.
  5. Fujiwara S, Yamano T, Hattori M, Fujiseki Y, Shimada M. Asymptomatic cerebral infarction in Kawasaki disease. Pediatr Neurol 1992;8:235-6. https://doi.org/10.1016/0887-8994(92)90077-C
  6. Tabarki B, Mahdhaoui A, Selmi H, Yacoub M, Essoussi AS. Kawasaki disease with predominant central nervous system involvement. Pediatr Neurol 2001;25:239-41. https://doi.org/10.1016/S0887-8994(01)00290-9
  7. Takanashi J, Shirai K, Sugawara Y, Okamoto Y, Obonai T, Terada H. Kawasaki disease complicated by mild encephalopathy with a reversible splenial lesion (MERS). J Neurol Sci 2012;315:167-9. https://doi.org/10.1016/j.jns.2011.11.022
  8. Bailie NM, Hensey OJ, Ryan S, Allcut D, King MD. Bilateral subdural collections--an unusual feature of possible Kawasaki disease. Eur J Paediatr Neurol 2001;5:79-81. https://doi.org/10.1053/ejpn.2001.0469
  9. Limbach HG, Lindinger A. Kawasaki syndrome in infants in the first 6 months of life. Klin Padiatr 1991;203:133-6. https://doi.org/10.1055/s-2007-1025416
  10. Chang FY, Hwang B, Chen SJ, Lee PC, Meng CC, Lu JH. Characteristics of Kawasaki disease in infants younger than six months of age. Pediatr Infect Dis J 2006;25:241-4. https://doi.org/10.1097/01.inf.0000202067.50975.90
  11. Yeom JS, Park JS, Seo JH, Park ES, Lim JY, Park CH, et al. Initial characteristics of Kawasaki disease with cerebrospinal fluid pleocytosis in febrile infants. Pediatr Neurol 2012;47:259-62. https://doi.org/10.1016/j.pediatrneurol.2012.06.011
  12. Dengler LD, Capparelli EV, Bastian JF, Bradley DJ, Glode MP, Santa S, et al. Cerebrospinal fluid profile in patients with acute Kawasaki disease. Pediatr Infect Dis J 1998;17:478-81. https://doi.org/10.1097/00006454-199806000-00008
  13. Terasawa K, Ichinose E, Matsuishi T, Kato H. Neurological complications in Kawasaki disease. Brain Dev 1983;5:371-4. https://doi.org/10.1016/S0387-7604(83)80041-2
  14. Takagi K, Umezawa T, Saji T, Morooka K, Matsuo N. Meningoencephalitis in Kawasaki disease. No To Hattatsu 1990;22:429-35.
  15. Aoki N. Subdural effusion in the acute stage of Kawasaki disease (Mucocutaneous lymph node syndrome). Surg Neurol 1988;29:216-7. https://doi.org/10.1016/0090-3019(88)90009-2