• Journal of Chest Surgery
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• v.28 no.4
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• pp.398-400
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• 1995

Kawasaki s disease is a multisystemic disorder that is an important cause of cardiovascular disease in children. We experienced a case of coronary artery aneurysm secondary to Kawasaki s disease. The patient was 12-year-old female presented as exertional dyspnea & chest pain[NYHA classII . Her coronary angiogram showed saccular aneurysms at proximal right coronary artery and proximal left anterior descending artery. CABG was performed by use of double internal mammary artery.Postoperative E.K.G. showed a normal pattern.She discharged at postoperative 10th day without problem. 4 months after discharge, she had no dyspnea & chest pain in exertion[NYHA class I .

• Clinical and Experimental Pediatrics
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• v.51 no.5
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• pp.452-456
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• 2008

Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that occurs predominantly in infants and young children. Initially described in 1967 by Dr. Tomisaku Kawasaki, it is now the most common cause of acquired heart disease among children in developed nations. Although KD has been reported across all racial and ethnic groups, the incidence of KD is more common among Asians, which suggests differences of race-specific susceptibility. The prevalence of the disease varies considerably among different Asian countries, and there is a higher rate of KD reported in Asian countries such as Japan and Korea than in other countries. In Korea, a nationwide epidemiological study has been conducted every three years since the 1990s by the Korean Pediatric Heart Association to determine the epidemiologic patterns and incidence rate of KD in Korea. It was thus found in a recent survey (2003-2005) that the average annual incidence of 105.0/100,000 Korean children under the age of five years was the second-highest reported rate in the world, after Japan.

• 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.

• Pediatric Infection and Vaccine
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• v.5 no.1
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• pp.147-151
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• 1998

On the treatment of Kawasaki disease, approximately 10% of children treated with IVIG have persistent or recrudescent fever despite IVIG treatment. We had experienced two children with Kawasaki disease who did not respond after multiple dosages of IVIG. They were treated within the first 10 days of onset of fever and were given oral aspirin (100mg/kg/day) and IVIG(2gm/kg) in a single infusion for 8 to 10 hours. The first child had not resolution of symptoms after three intravenous doses of IVIG(total 4gm/kg). And then treated with high dose methylprednisolone(30mg/kg) for 2 to 3 hours intravenously without symptoms improvement. On fifth hospital days, he was retreated with IVIG (2gm/kg) again with ultimate resolution of symptoms. The second child had resolution of symptoms after three intravenous doses of IVIG(total 4gm/kg). No adverse events were associated with the administration of IVIG or steroid. We reported two cases of IVIG non-responded Kawasaki disease with a brief review of the related literatures.

• Clinical and Experimental Pediatrics
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• v.48 no.3
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• pp.315-320
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• 2005

Objective : Toll like receptor(TLR) is known to be involved in innate immunity. Many microbial antigens stimulate TLR, and as a result of intracellular signal transduction, they activate nuclear factor-kB which produces diverse inflammtory cytokines. Until now, many research topics in Kawasaki disease focused on cytokine increasement. In this study, we aim to reveal TLR increasement which might be associated with initiation of inflammatory response. Methods : We obtained the peripheral blood of ten patients who were diagnosed with Kawasaki disease in Yonsei University College of Medicine from March 2003 to August 2003, as well as those of a febrile control group and the same number of a normal control group. Flow cytometry was done in all samples for quantification of TLR-2 expression in CD14 positive monocyte. And we also extracted total RNA of periphral monocyte and quantificated expression of TLR-2 mRNA by RT-PCR. Results : The expression of TLR-2 in Kawasaki disease increased significantly compared with the normal control group but not when compared with the febrile control group. And the expression decreased slightly in the subacute phase of Kawasaki disease compared with the acute phase, but this was statistically insignificant. mRNA expression of TLR-2 in peripheral blood monocyte also increased in the acute phase of Kawasaki disease. Conclusion : Expression of TLR-2 in Kawasaki disease increased when compared with the normal control group, which means that innate immunity is associated with the pathogenesis of Kawasaki disease.

• Clinical and Experimental Pediatrics
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• v.62 no.4
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• pp.119-123
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• 2019

Kawasaki disease (KD) is a systemic vasculitis that mainly affects younger children. Intravenous immunoglobulin (IVIG) resistant cases are at increasing risk for coronary artery complications. The strategy on prediction of potential nonresponders and treatment of IVIG-resistant patients is now controversial. In this review the definition and predictors of IVIG-resistant KD and current evidence to guide management are discussed.

• Clinical and Experimental Pediatrics
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• v.48 no.4
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• pp.438-442
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• 2005

Kawasaki disease is an acute febrile vasculitis that occurs predominantly in young children under 5-years-old. The patients present generally with a high spiking fever that is unresponsive to antibiotics and lasts for more than five days at least. Prolonged fever has been shown to be a risk factor in the development of coronary artery disease. It seems to be certain that infectious agents are associated with the pathogenesis of Kawasaki disease. The differential diagnosis of Kawasaki disease must rule out infectious diseases including scarlet fever, toxic shock syndrome, measles, and so on. This is very important for adequate treatment and prevention of cardiac complications of Kawasaki disease. We experienced a 25-month-old boy who had high fever and pneumonic consolidation in the right middle and lower lobe of the lung that was considered as mycoplasma pneumonia on admission and developed coronary artery aneurysmal dilatation during treatment with roxythromycin.

• Clinical and Experimental Pediatrics
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• v.58 no.10
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• pp.369-373
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• 2015

Purpose: In 2004, the American Heart Association (AHA) had published an algorithm for the diagnosis of incomplete Kawasaki disease (KD). The aim of the present study was to investigate characteristics of supplemental laboratory criteria in this algorithm. Methods: We retrospectively examined the medical records of 355 patients with KD who were treated with intravenous immunoglobulin (IVIG) during the acute phase of the disease. Laboratory data were obtained before the initial IVIG administration and up to 10 days after fever onset. In 106 patients, laboratory testing was performed more than twice. Results: The AHA supplemental laboratory criteria were fulfilled in 90 patients (25.4%), and the frequency of laboratory examination (odds ratio [OR], 1.981; 95% confidence interval [CI], 1.391-2.821; P<0.001) was a significant predictor of it. The fulfillment of AHA supplemental laboratory criteria was significantly associated with refractoriness to the initial IVIG administration (OR, 2.388; 95% CI, 1.182-4.826; P=0.013) and dilatation of coronary arteries (OR, 2.776; 95% CI, 1.519-5.074; P=0.001). Conclusion: Repeated laboratory testing increased the rate of fulfillment of the AHA supplemental laboratory criteria in children with KD.

• Clinical and Experimental Pediatrics
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• v.45 no.5
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• pp.664-668
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• 2002

A twenty six months-old boy developed hemophagocytic syndrome during the course of Kawasaki disease. Despite the appropriate treatment modalities for Kawasaki disease, he developed thrombocytopenia, hepatomegaly, high-grade fever, hypertriglyceridemia, peripheral gangrene, and evidence of hemophagocytosis in bone marrow biopsy. Although the course was stormy, he responded well to a combination therapy of corticosteroid and etoposide.

• Clinical and Experimental Pediatrics
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• v.62 no.4
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• pp.138-143
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• 2019

Purpose: Prognostic factors of coronary aneurysms in Kawasaki disease have been investigated in many studies. The aim of this study was to identify risk factors associated with early and late coronary artery outcomes in treated patients with Kawasaki disease. Methods: A total of 392 patients diagnosed with Kawasaki disease from January 2012 to December 2015 in Pusan National University Children's Hospital were retrospectively selected as subjects of the present study to determine risk factors for coronary aneurysms and persistence of coronary aneurysms after a 1-year follow-up. Results: Coronary aneurysms were detected in 30 of 392 patients within 1 month after the occurrence of Kawasaki disease. Coronary aneurysms persisted in 5 of 30 patients after a 1-year follow-up. A long duration of fever (adjusted odds ratio [OR], 1.47; 95% confidence interval [CI], 1.06-2.02; P=0.018) and high platelet count (adjusted OR, 1.00; 95% CI, 1.00-1.01; P=0.009) were found to be independent factors to predict the development of coronary aneurysms in the early phase. Initial coronary severity (adjusted OR, 46.0; 95% CI, 2.01-1047.80; P=0.016) and a high white blood cell count (adjusted OR, 1.17; 95% CI, 1.01-1.36; P=0.028) were found to be significant factors for the persistence of late coronary aneurysms in univariate analysis. However, no significant factors were found in multivariate analysis. Conclusion: These data are from early and late follow-up of coronary aneurysms in our unit. Further studies are needed to determine the mechanisms involved in the disappearance of coronary aneurysms and related factors.