Kawasaki disease with pulmonary nodules: two case reports and literature review

In this study, we report case studies of two infants diagnosed with Kawasaki disease with pulmonary nodules. The typical symptoms of Kawasaki disease include changes to the lips and oral cavity, including reddening of the lips and strawberry tongue, the diffuse injection of oral and pharyngeal mucosa, a rash (including redness at the site of the Bacille Calmette-Guerin inoculation), and changes to peripheral extremities, which in the initial stage include the reddening of palms and soles and edema, and in the convalescent stage include periungual desquamation and non-suppurative cervical lymphadenopathy. One of the patients had mild, transient bilateral conjunctival redness, and the other patient had a fever. However, chest imaging revealed multiple lung nodules, and echocardiography revealed coronary artery dilatation. Based on the symptoms, the laboratory indicators and echocardiography, diagnoses of incomplete Kawasaki disease were confirmed. The physicians provided treatments to the patients that significantly alleviated their conditions, including intravenous immunoglobulin (IVIG) and aspirin. The coronary arteries of the two infants returned to normal, and the lung nodules of the two infants disappeared. We conducted a literature search and identified publications in which nine children reported pulmonary nodules associated with Kawasaki disease. At present, lung damage remains a challenge in diagnosing and differential diagnosis of Kawasaki disease and incomplete Kawasaki disease.