Early combined treatment with steroid and immunoglobulin is effective for serious Kawasaki disease complicated by myocarditis and encephalopathy

Suga, Kenichi; Inoue, Miki; Ono, Akemi; Terada, Tomomasa; Kawahito, Masami; Mori, Kazuhiro

doi:10.2152/jmi.63.140

Cited by 9 publications

(4 citation statements)

References 6 publications

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“…4,5,[9][10][11]18 Some authors have reported IVMP as a rescue therapy in children with refractory KD who had myocarditis and symptomatic congestive heart failure during the acute stage of the disease. [19][20][21] Some studies have shown that 51%-80% of patients with MIS-C did not respond to IVIG treatment, 6,10 while 70% of our patients with MIS-C appear to be unresponsive to IVIG. CS was added to this group's therapy on day 3 on average.…”

Section: Discussionmentioning

confidence: 62%

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Recent Experience: Corticosteroids as a First-line Therapy in Children With Multisystem Inflammatory Syndrome and COVID-19-related Myocardial Damage

Vukomanović

Krasić

Prijić

et al. 2021

Pediatric Infectious Disease Journal

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Section: Discussionmentioning

confidence: 62%

“… 4 , 5 , 9 – 11 , 18 Some authors have reported IVMP as a rescue therapy in children with refractory KD who had myocarditis and symptomatic congestive heart failure during the acute stage of the disease. 19 – 21 …”

Section: Discussionmentioning

confidence: 99%

Recent Experience: Corticosteroids as a First-line Therapy in Children With Multisystem Inflammatory Syndrome and COVID-19-related Myocardial Damage

Vukomanović

Krasić

Prijić

et al. 2021

Pediatric Infectious Disease Journal

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“…Kawasaki disease (KD) is a rare pediatric systemic vasculitis that typically affects medium-sized arteries, particularly the coronary arteries. The disorder was first described by pediatrician Tomisaku Kawasaki in Japan in 1967 [ 19 ]. In developed countries, Kawasaki disease is the leading cause of acquired heart disease.…”

Section: Comparison Of Mis-c With Kawasaki Diseasementioning

confidence: 99%

Multisystem Inflammatory Syndrome in Children (MIS-C)

Patel

2022

Curr Allergy Asthma Rep

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Purpose of Review The novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has developed into a pandemic. A unique challenge of this pandemic has been the emergence of multisystem inflammatory syndrome in children (MIS-C), a rare post-infectious hyperinflammatory disorder associated with SARS-CoV-2. This syndrome is characterized by overwhelming systemic inflammation, fever, hypotension, and cardiac dysfunction. This disorder may also have features overlapping with Kawasaki disease (KD), macrophage activation syndrome (MAS), and toxic shock syndrome (TSS). The goal of this review is to outline the presenting features, presumed immunopathogenesis, management, and outcomes of patients with MIS-C. Recent Findings Patients with MIS-C present with characteristics that fall within a wide clinical spectrum. Main features include fever, gastrointestinal symptoms such as abdominal pain and diarrhea, and cardiac complications such as myocarditis and coronary artery aneurysms, although various other features have been reported. Younger children may present with features of Kawasaki-like disease, and older children are often admitted to the intensive care unit with cardiogenic shock. Current treatment guidelines recommend intravenous immunoglobulins (IVIG) and glucocorticoids, with utilization of biologics in refractory cases. Fortunately, the majority of patients recover, with resolution of the systemic inflammation and cardiac abnormalities. Mortality from MIS-C is rare. Summary This review provides an overview of the presenting features, proposed pathogenesis, suggested therapies, and outcomes of MIS-C. Clinicians must have a high clinical suspicion for this disorder in children who have had recent COVID-19 infection or exposure and present with a significant inflammatory response. Understanding of this disorder continues to evolve, and prompt diagnosis and treatment allow for the best possible outcome for patients with MIS-C.

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“…Classically, diagnosis of KD is based on clinical criteria represented by persistent fever for five or more days with at least four of five main clinical features, which tend to appear sequentially: bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, polymorphous rash, cervical lymphadenopathy, and abnormalities of hands and feet, including also perineal erythema ( Table 1 ) [ 5 ]. Typically, all these clinical features are not present at the time of fever onset.…”

Section: Introductionmentioning

confidence: 99%

Early Desquamating Perineal Erythema in a Febrile Infant: A Characteristic Clinical Feature of Kawasaki Disease

Isidori

Sebastiani

Cardellini

et al. 2017

IJERPH

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Background: The occurrence of a distinctive perineal eruption that appears early in infants with Kawasaki disease (KD), the most relevant type of febrile vasculitis of childhood, has received little attention in pediatric reports. KD diagnosis is based on clinical criteria, which can be supported by laboratory abnormalities or positive echocardiography findings: difficulty in diagnosis can be increased by incomplete or atypical presentations, but a timely diagnostic process is essential in the youngest patients who are more prone to the risk of cardiac sequelae resulting from KD. Case Presentation: In this report, we present the case of a 2-month-old infant with an unusual presentation of KD, in whom diagnosis was made despite fever remission on the fourth day of hospitalization following intravenous corticosteroid therapy to treat concomitant bronchoconstriction. The presence of early desquamating perineal erythema led to the consideration of KD diagnosis, confirmed by the echocardiographic assessment of right and left coronary artery dilatations with pericardial effusion on the fifth day of hospital stay. Conclusions: Diagnosis of KD represents a demanding challenge, mainly when the illness starts with an incomplete or nuanced presentation. An erythematous desquamating perineal rash is a valuable early clinical clue, which might facilitate a prompt diagnosis of KD. This case emphasizes that an accurate assessment of all clinical features, including perineal erythema with early tendency to desquamation, and an eventual echocardiography, are necessary in an infant displaying fever to corroborate the suspicion of KD.

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Early combined treatment with steroid and immunoglobulin is effective for serious Kawasaki disease complicated by myocarditis and encephalopathy

Cited by 9 publications

References 6 publications

Recent Experience: Corticosteroids as a First-line Therapy in Children With Multisystem Inflammatory Syndrome and COVID-19-related Myocardial Damage

Recent Experience: Corticosteroids as a First-line Therapy in Children With Multisystem Inflammatory Syndrome and COVID-19-related Myocardial Damage

Multisystem Inflammatory Syndrome in Children (MIS-C)

Early Desquamating Perineal Erythema in a Febrile Infant: A Characteristic Clinical Feature of Kawasaki Disease

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