Browse > Article
http://dx.doi.org/10.14776/piv.2016.23.2.102

Severe Skin Lesions or Arthritis May be Associated with Coronary Artery Lesions in Kawasaki Disease  

Youn, Song Ee (Department of Pediatrics, Kyung Hee University Hospital)
Ju, Hee Young (Department of Pediatrics, Kyung Hee University Hospital at Gangdong)
Lee, Kyung Suk (Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine)
Cha, Sung Ho (Department of Pediatrics, Kyung Hee University Hospital)
Han, Mi Young (Department of Pediatrics, Kyung Hee University Hospital)
Yoon, Kyung Lim (Department of Pediatrics, Kyung Hee University Hospital at Gangdong)
Publication Information
Pediatric Infection and Vaccine / v.23, no.2, 2016 , pp. 102-108 More about this Journal
Abstract
Purpose: Kawasaki disease (KD) shows a variety of clinical signs of multi-system involvement, including clinical diagnostic criteria. It is unknown that the severity of the clinical signs is associated with the risk of coronary artery lesions (CALs). We wanted to evaluate clinical characteristics and the risk of CALs in the patient groups who had severe skin lesions or those with arthritis. Methods: We retrospectively reviewed the medical records of 220 KD patients who were treated with intravenous immunoglobulin (IVIG). We compared clinical and laboratory data between the group with severe skin lesions (n=52) and those with mild or no skin lesions (n=168), and between the group with arthritis (n=6) and those without arthritis (n=214). Results: The mean age of total patients was $2.23{\pm}1.87years$ of age, and the male-to-female ratio was 1.5:1 (138/82). Among 220 patients, 52 patients had CALs (23.6%), and 29 patients (13.2%) showed incomplete KD. The patients with CALs had a higher mean age, longer total fever duration, and higher rate of IVIG non-responsiveness. The patient group with severe skin lesions showed a higher mean age (P<0.001), more prolonged fever duration (P=0.041), higher frequency of CALs (P=0.033), higher WBC, neutrophil, and neutrophil-to-lymphocyte ratio levels, compared to the patient group without severe skin lesions. The patients with arthritis had a tendency of further treatment with methylprednisolone or infliximab. Conclusions: The frequency of CALs was higher in patient group with severe skin lesions. Our results suggest that the intensity of clinical signs of KD such as skin rash, cervical lymphadenopathy and possibly arthritis may be associated the risk of CALs.
Keywords
Kawasaki disease; Coronary artery lesion; Skin rash; Arthritis;
Citations & Related Records
Times Cited By KSCI : 2  (Citation Analysis)
연도 인용수 순위
1 Kwan YW, Leung CW. Pustulo-vesicular skin eruption in a child with probable Kawasaki disease. Eur J Pediatr 2005; 164:770-1.   DOI
2 Vierucci F, Tuoni C, Moscuzza F, Saggese G. Consolini R. Erythema multiforme as first sign of incomplete Kawasaki disease. Ital J Pediatrics 2013;39:11.   DOI
3 Passeron T, Olivier V, Sirvent N, Khalfi A, Boutte P, Lacour JP. Kawasaki disease with exceptional cutaneous manifestations. Eur J Pediatr 2002;161:228-30.   DOI
4 Lee KY, Oh JH, Han JW, Lee JS, Lee BC. Arthritis in Kawasaki disease after responding to intravenous immunoglobulin treatment. Eur J Pediatr 2005;164:451-2.   DOI
5 Hicks RV, Melish ME. Kawasaki syndrome; rheumatic complaints and analysis of salicylate therapy. Arthritis Rheum 1979;22:621-2.
6 Lefevre-Utile A, Galeotti C, Kone-Paut I. Coronary artery abnormalities in children with systemic-onset juvenile idiopathic arthritis. Joint Bone Spine 2014;81:257-9.   DOI
7 Kumar S, Vaidyanathan B, Gayathri S, Rajam L. Systemic onset juvenile idiopathic arthritis with macrophage activation syndrome misdiagnosed as Kawasaki disease: case report and literature review. Rheumatol Int 2013;33:1065-9.   DOI
8 Rigante D, Valentini P, Onesimo R, Angelone DF, Nisco AD, Bersani G, et al. Incomplete Kawasaki syndrome followed by systemic onset-juvenile idiopathic arthritis mimicking Kawasaki syndrome. Rheumatol Int 2010;30:535-9.   DOI
9 Lee KY. A common immunopathogenesis mechanism for infectious diseases: The protein-homeostasis-system hypothesis. Infect Chemother 2015;47:12-26.   DOI
10 Gong WK, McCrindle BW, Ching JC, Yeung RS. Arthritis presenting during the acute phase of Kawasaki disease. J Pediatr 2006;148:800-5.   DOI
11 Kim JS. Pathogenesis of Kawasaki disease. J Korean Pediatr Heart 2005;9:284-7.
12 Newburger JW, Takahashi M, Gerber MA, Gewitz MH, TaniL Y, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics 2004;114:1708-33.   DOI
13 Mathes EF, Gilliam AE. A four year old boy with fever, rash, and arthritis. Semin Cutan Med Surg 2007;26:179-87.   DOI
14 Lee KY, Rhim JW, Kang JH. Kawasaki disease: laboratory findings and an immunopathogenesis on the premise of a "Protein homeostasis system". Yonsei Med J 2012;53:262-75.   DOI
15 Kanegaye JT, Van Cott E, Tremoulet AH, Salgado A, Shimizu C, Kruk P, et al. Lymph-node-first presentation of Kawasaki disease compared with bacterial cervical adenitis and typical Kawasaki disease. J Pediatr 2013;162:1259-63.   DOI
16 Duzova A, Topaloglu R, Keskin M, Ozcelik U, Secmeer G, Tokgozoglu AM. An unusual pattern of arthritis in a child with Kawasaki syndrome. Clin Rheumatol 2004;23:73-5.   DOI
17 Vecchietti G, Kerl K, Prins C, Kaya G, Saurat JH, French LE. Severe eczematous skin reaction after high-dose intravenous immunoglobulin infusion: report of 4 cases and review of the literature. Arch Dermatol 2006;142:213-7.
18 Falcini F, Ricci L, Poggi GM, Simonini G, Calabri GB, De Martino M. Severe cutaneous manifestations in a child with refractory Kawasaki disease. Rheumatology 2006;45:1444-5.   DOI
19 Hicks RV, Melish ME. Arthritis in Kawasaki syndrome: further characterization. Arthritis Rheum Suppl 1982;25:S18.
20 Jen M, Brucia LA, Pollock AN, Burnham JM. Cervical spine and temporomandibular joint arthritis in a child with Kawasaki disease. Pediatrics 2006;118:e1569-71.   DOI
21 Yeung RS. Phenotype and coronary outcome in Kawasaki's disease. Lancet 2007;369:85-7.   DOI
22 Arjunan K, Daniels SR, Meyer RA, Schwartz DC, Barron H, Kaplan S. Coronary artery caliber in normal children and patients with Kawasaki disease but without aneurysms: an echocardiographic and angiographic study. J Am Coll Cardiol 1986;8:1119-24.   DOI
23 Ueno K, Nomura Y, Morita Y, Eguchi T, Masuda K, Kawano Y. Circulating platelet-neutrophil aggregates play a significant role in Kawasaki disease. Circ J 2015;79:1349-56.   DOI
24 Ha KS, Lee J, Jang GY, Lee J, Lee KC, Son CS, et al. Value of neutrophil-lymphocyte ratio in predicting outcomes in Kawasaki disease. Am J Cardiol 2015;116:301-6.   DOI