• Journal of Yeungnam Medical Science
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• v.34 no.1
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• pp.106-110
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• 2017

Kawasaki disease (KD) is an acute vasculitis of small and medium sized arteries. Even many years after onset, aneurysms and stenosis in coronary arteries may lead to an acute myocardial infarction, which is described as atypical or missed KD in childhood. KD is an underlying disease of young adults with acute myocardial infarction. We report on a rare case involving a total occlusion in the proximal left anterior descending coronary artery combined with a giant left main aneurysm in a young adult patient with acute myocardial infarction ascribed to antecedent KD that is undefined but almost certain.

• Clinical and Experimental Pediatrics
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• v.46 no.2
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• pp.207-209
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• 2003

Kawasaki disease is an acute febrile vasculitis affecting primarily infants and young children. In addition to the cardiovascular involvement, it may cause inflammatory changes in various organs and body systems : digestive, respiratory, urinary, nervous and musculoskeletal. A case is reported of atypical Kawasaki disease associated with acute renal failure and necrotizing myositis in the right gastrocnemius in a 10-year-old boy. In older children, uncommon age of onset and additional features less commonly associated with Kawasaki disease may contribute to a delayed diagnosis.

• Clinical and Experimental Pediatrics
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• v.45 no.3
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• pp.376-382
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• 2002

Purpose : To identify clinical and laboratory features of atypical Kawasaki disease(KD), and to develop criteria for early diagnosis of atypical KD patients. Methods : All patients with KD treated at our hospital from January 1998 to June 2000 were reviewed retrospectively. Results : Among a total of 167 patients, 28(16.8%) were atypical KD of which seven(25%) were infants. Among the five cardinal symptoms, oral mucosal change(96.4%) occurred most frequently, followed by conjuntivitis(57.1%) and rash(46.4%). Most notable laboratory findings were anemia, and increased erythrocyte sedementation rate(ESR) or C-reactive protein(CRP). Coronary artery abnormalities developed in seven(25.8%) atypical KD patients, compared with 14.4% in typical KD patients. We considered oral mucosal change as major criterion, and conjunctivitis, rash, hematocrit <35% and ESR >30 mm/hr or CRP >3.1 mg/dL as minor criteria. Proposed modification in diagnostic criteria for atypical KD include fever of ${\geq}5$ days＋major criterion＋${\geq}2$ minor criteria, or fever of ${\geq}5$ days＋4 minor criteria. Conclusion : The modified diagnostic criteria has yielded a sensitivity 89.3%. Our diagnostic criteria may be used for early diagnosis of atypical KD.

• Pediatric Infection and Vaccine
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• v.21 no.3
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• pp.214-218
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• 2014

Kawasaki disease is generally diagnosed base on its clinical features. Sometimes unusual or atypical presentations make the diagnosis of Kawasaki disease difficult. We experienced an unusual case of Kawasaki disease presented with unilateral parotitis in a 23-month old girl. Despite of intravenous antibiotics treatment, fever and unilateral parotid swelling persisted. Skin rashes, conjunctival injections, and coronary abnormalities showed up on the 8th day of fever. After the intravenous immunoglobulin and salicylates treatment, all symptoms disappeared. Although unilateral parotitis is very unusual presentation of Kawasaki disease, in case of no response to antibiotics, Kawasaki disease should be included in the differential diagnosis.

• Clinical and Experimental Pediatrics
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• v.45 no.8
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• pp.1048-1051
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• 2002

Toxic shock syndrome(TSS) is clinically similar to Kawasaki disease(KD) in that both of them are characterized by fever, desquamating rash and mucous membrane erythema. In contrast the main feature of TSS is hypotension, whereas the complication of KD is coronary vasculitis. We report an 8-year-old boy who fulfilled the crireria for TSS and KD. Initially he showed clinical features of TSS, so he was treated with intravenous antibiotics and supportive management. But the fever sustained, and the coronary aneurysm that is the main complication of Kawasaki disease was shown by echocardiogram on Day 14. He was treated with intravenous immunoglobulin twice and the fever subsided and general condition was improved.

• Clinical and Experimental Pediatrics
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• v.52 no.2
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• pp.251-255
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• 2009

Kawasaki disease is an acute systemic inflammatory disorder, the etiology of which has not yet been established. The clinical manifestations are non-specific and are common to many pediatric infectious and immunologic diseases. In 2 cases presenting fever, cervical lymphadenopathy, and retropharyngeal abscess-like lesions on the neck shown in a computerized tomography (CT) scan, the diagnosis of Kawasaki disease was delayed. The patients were not responsive to antibiotic therapy, and fluid collection was not found during retropharyngeal aspiration. They showed typical Kawasaki manifestations over time and atrioventricular valve regurgitation in the echocardiogram. A diagnosis of Kawasaki disease should be considered in similar cases of fever and cervical lymphadenopathy. A CT scan that shows a retropharyngeal abscess-like lesion on the neck can be a false positive finding, and other laboratory exams, including echocardiography, should be performed as early as possible to avoid unnecessary medical and surgical procedures.

• Clinical and Experimental Pediatrics
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• v.46 no.6
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• pp.591-596
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• 2003

Purpose : Kawasaki disease(KD) is rare in infants <3 months of age. In this younger group, the diagnosis may be delayed due to lack of most of the clinical criteria, resulting in a high risk of cardiac complications. We examined clinical characteristics in these patients for early recognition and treatment. Methods : We conducted a retrospective study on the infants with KD aged three months or younger treated at our hospital from January 1998 to July 2002. Results : Of a total of 291 patients treated during the study period, 11(3.8%) were three months old or younger. Of the 11 patients, 10 had atypical presentations. Infants had fewer of the accepted criteria, and the most common findings were fever(100%) and oral mucosal changes(72.7%). Erythema at the site of BCG inoculation was observed in six of the 11 patients(unknown in the remaining five). This feature proved a definite diagnostic clue in two patients in whom cardiac complications developed in the subacute phase. Cardiac complications were found in six patients(54.5%) : three had coronary dilatation, two had coronary wall irregularity, and one had mitral valve prolapse with regurgitation. Defervescence occurred within $1.1{\pm}0.3day$ in 10 of the 11 patients treated with intravenous immunoglobulin(IVIG) and one was given a second course of IVIG. Echocardiographic abnormality persisted in only one patient with mitral regurgitation at the 6-month follow-up. Conclusion : Most patients with KD younger than three months of age have atypical presentations and a high complication rate. For early diagnosis, erythema at the BCG inoculation site, if present, could be used as a valid diagnostic clue to atypical KD in this age group.

• Clinical and Experimental Pediatrics
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• v.52 no.3
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• pp.389-391
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• 2009

Antiepileptic drug hypersensitivity syndrome (AHS), a delayed immunological reaction, is a relatively rare side effect of antiepileptic drugs and is usually overlooked. An array of symptoms can occur one to eight weeks after treatment with an antiepileptic drug. Symptoms may be as simple as a fever, skin rash, or lymphadenopathy, but may eventually involve internal organs and cause fatal outcomes. Additionally, because the symptoms resemble the features of various arrays of diseases and the reported mortality rate is approximately 10%, the importance of early diagnosis and ability to differentiate AHS from other diseases cannot be overemphasized. We report a case of a 14-year-old girl with AHS caused by lamotrigine, which mimicked atypical Kawasaki disease and infectious mononucleosis.

• Pediatric Infection and Vaccine
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• v.12 no.2
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• pp.101-107
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• 2005

Purpose : We evaluated the C-reactive protein(CRP), white blood cell(WBC) and neutrophil levels in the various infectious diseases in a single hospital. Methods : A total of 640 medical records of children with infectious diseases such as bacterial meningitis(19 cases), acute pyelonephritis(55 cases), measles(253 cases), chicken pox (38 cases), mycoplasma pneumonia(160 cases), tsutsugamushi disease(39 cases) and Kawasaki disease(152 cases) admitted to The Catholic University of Korea, Daejeon St. Mary's hospital from 1996 to 2002 were retrospectively analyzed. Results : The mean CRP level was $17.9{\pm}6.4mg/dL$ in bacterial meningitis, $9.1{\pm}5.6mg/dL$ in Kawasaki disease, and $8.1{\pm}3.3mg/dL$ in acute pyelonephritis. In the mycoplasma pneumonia and tsutsugamush disease group(atypical bacterial group), the CRP level was $3.2{\pm}2.5mg/dL$, and $1.0{\pm}0.8mg/dL$ in the viral diseases group(measles and chicken pox). There were also significant differences for the WBC count and neutrophil differential between the 3 infectious groups with higher level in the bacterial infections group($15,600{\pm}6,100/mm^3$, $62{\pm}21%$) than in the atypical bacterial infections and in the viral infections group($9,600{\pm}3,300mm^3$, $57{\pm}11%$ and $7,300{\pm}2,900/mm^3$, $49{\pm}16%$, respectively). The inflammatory indices in Kawasaki disease were like those of bacterial infections. There was a correlation between CRP level and WBC or neutrophil count in the bacterial infections and Kawasaki disease groups. Conclusion : The CRP, WBC and neutrophil levels showed a clear difference between the infectious diseases according to causative agents. The WBC and neutrophil level was different according to age in measles and mycoplasma pneumonia. There was a correlation between CRP level and WBC or neutrophil count in the bacterial infections and Kawasaki disease groups.

• Pediatric Infection and Vaccine
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• v.30 no.2
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• pp.97-103
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• 2023

Kawasaki disease (KD) is an acute, systemic inflammatory disorder that often targets coronary arteries. Being the common cause of acquired heart disease in children, timely diagnosis and intravenous immunoglobulin treatment are crucial. However, it is challenging for physicians to diagnose KD if it presents with atypical manifestations. We report the case of a 5-year-old boy who initially presented with appendicitis; after an appendectomy, he had a prolonged fever. He was finally diagnosed with atypical KD and successfully recovered after intravenous immunoglobulin treatment. Through a literature review, we found 21 cases of appendicitis associated with KD. In most cases, the patients were male with a mean age of 5.3 years. Most had higher proportions of incomplete KD and coronary artery complications than expected for typical KD. In conclusion, appendicitis could be a rare complication of KD; therefore, multidisciplinary cooperation and early recognition of atypical KD are essential for timely diagnosis.