Comorbidity of Kawasaki disease and group A streptococcal pleural effusion in a healthy child: a case report

Abstract

BackgroundKawasaki disease is an acute self-limiting vasculitis that affects children. The most dreaded complication of Kawasaki disease reported in the literature over the years is coronary artery disease, which is considered as the main cause of acquired heart disease. However, pulmonary associations with Kawasaki disease have been overlooked. We present a rare, if not unique, case of Kawasaki disease associated with group A streptococcus pleural effusion in the English language literature. A search of the PubMed database was carried out, using a combination of the terms “Kawasaki disease”, “pneumonia”, and “group A streptococcus”. The majority of studies conducted in children with Kawasaki disease have concentrated on the coronary artery implications. Kawasaki disease is considered a self-limiting illness, but can have detrimental consequences if not diagnosed early. When there is a prolonged inflammatory reaction, with no infectious agent identified or remittent fever unresponsive to antibiotics, Kawasaki disease should be taken into consideration. Elevated Vβ2+ T cells compared with healthy controls suggest possible involvement of a superantigen in the etiology of Kawasaki disease, so it is wise that the health care provider concentrates not only on the cardiac consequences, but also on pulmonary associations.

Pleural effusion as an atypical presentation of Kawasaki disease: a case report and review of the literature

“…reported the case of an adult patient who presented with pulmonary involvement, specifically bilateral massive pleural effusions [10]. Occasionally, pleural effusion may be associated with bacterial agents such as Mycoplasma pneumoniae and Streptococcus [11, 12]. Pulmonary symptoms are mostly initially treated with antibiotics.…”

“…However, if fever and accompanying signs ensue, the diagnosis of KD should be considered. Patients with pulmonary involvement may be more likely to have CAI due to delays in diagnosing KD and administration of IVIG [12–17].…”

“…Finally, 20 patients with pleural effusions due to KD were identified [6, 11–18, 20, 24]. Of the 20 reviewed patients, TTE results were available in nine patients and seven had CAI [6, 12–17, 24]. Eleven patients presented with respiratory symptoms such as cough, dyspnea, and tachypnea [6, 12–15, 20].…”

“…Of the 20 reviewed patients, TTE results were available in nine patients and seven had CAI [6, 12–17, 24]. Eleven patients presented with respiratory symptoms such as cough, dyspnea, and tachypnea [6, 12–15, 20]. Only four patients [14, 17, 18, 24] had complete KD, 10 patients [6, 13, 15, 16, 20] had incomplete KD, and six patients’ [11, 12] presentations were not available.…”

Kawasaki Shock Syndrome in a 12-Year-Old Girl Mimicking Septic Shock

“…Pleural effusions can occur due to concurrent infections like Mycoplasma and Streptococcus [6, 7]. Increased microvascular permeability is seen in vasculitis of KD which may account for periorbital oedema [8].…”