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Afebrile Kawasaki disease with coronary artery dilatation

Atsunori Yoshino1,2,3, Risa Tanaka1, Tadamasa Takano1

  • 1Department of Microbiology and Immunology, Saitama Children's Medical Center, Saitama City, Saitama, Japan.

Pediatrics International : Official Journal of the Japan Pediatric Society
|March 21, 2017
PubMed

Insights

Two afebrile patients were diagnosed with incomplete Kawasaki disease (KD). Redness at the Bacillus Calmette-Guerin (BCG) inoculation site aided diagnosis, highlighting its utility in identifying KD without fever.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Cardiology

Background:

  • Kawasaki disease (KD) is a leading cause of acquired heart disease in children.
  • Fever is a primary diagnostic criterion for KD, but incomplete or atypical presentations occur.
  • Diagnosis can be challenging in afebrile patients.

Observation:

  • Two afebrile pediatric patients presented with symptoms suggestive of KD.
  • Patient 1 exhibited conjunctival injection, diarrhea, erythema, and BCG site redness, with subsequent coronary artery (CA) dilatations.
  • Patient 2 showed conjunctival injection and BCG site redness, developing CA dilatations.

Findings:

  • Both patients, despite being afebrile, were diagnosed with incomplete Kawasaki disease.
  • Ultrasonic cardiogram revealed bilateral coronary artery dilatations in both cases.
  • Redness at the Bacillus Calmette-Guerin (BCG) inoculation site served as a potential diagnostic clue.

Implications:

  • Afebrile presentations of Kawasaki disease are possible and require careful evaluation.
  • BCG site reactivity may be an important, often overlooked, clinical sign in diagnosing incomplete KD.
  • Early recognition and diagnosis are crucial for timely management and prevention of cardiac sequelae.

Keywords:
Kawasaki diseaseafebrilebacillus Calmette-Guerincoronary artery dilationheat shock protein

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