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Kawasaki disease, or mucocutaneous lymph node syndrome: report of seven cases in North America
Insights
Kawasaki disease in children can present with severe complications, including cardiac issues. Misdiagnosis of milder forms as common febrile illnesses may delay critical treatment for pediatric patients.
Area of Science:
- Pediatrics
- Infectious Diseases
- Rheumatology
Background:
- Kawasaki disease is an acute febrile illness affecting young children.
- North American cases often exhibit more severe clinical presentations.
Observation:
- This review analyzes seven pediatric cases of Kawasaki disease.
- Common symptoms included fever, rash, conjunctivitis, and oral mucosal changes.
- Complications observed were cardiac involvement (aneurysm/thrombosis), arthritis, aseptic meningitis, and jaundice.
Findings:
- Four out of seven patients presented with severe disease, mirroring North American trends.
- Cardiac complications, such as coronary artery aneurysm, occurred in two patients.
- Gastrointestinal issues, including jaundice and gallbladder hydrops, were noted in three patients, with one fatal outcome due to sepsis and DIC.
Implications:
- Severe Kawasaki disease requires prompt recognition and management to prevent long-term sequelae.
- Milder presentations may be underdiagnosed, highlighting the need for increased clinical awareness.
- Understanding disease spectrum is crucial for effective pediatric care and research.
Abstract:
The clinical and laboratory findings in seven children with Kawasaki disease are reviewed. Four of the patients had the more complicated course that has characterized the cases diagnosed in North America. This suggests that the benign forms are often mistaken for other febrile illnesses. The patients were two girls and five boys ranging in age from 4 months to 7 years; six were Caucasian and one was a North American Indian. Fever, redness of the oral mucosa, an erythematous or scarlatiniform rash and cervical adenopathy were seen in all; six patients had the characteristic fingertip desquamation and nonexudative conjunctivitis. Cardiac involvement occurred in four patients, two of whom had coronary artery aneurysm or thrombosis. Arthritis or arthralgia was seen in six patients, and aseptic meningitis occurred in four. Of the three patients with jaundice two underwent laparotomy and excision of a hydropic gallbladder; one of them died from Klebsiella pneumoniae sepsis and disseminated intravascular coagulopathy.