Kawasaki disease: An unusual presentation in a 14-year old boy in Sokoto, north western Nigeria

Abstract

Kawasaki disease (KD) is an acute systemic vasculitis that mostly affects children less than 5years. Occasionally, it may presents with renal involvement of varying severity. In Nigeria and most of Africa, only a few cases of KD have been reported and these were among children within the typical age group. We report an unusual case of Kawasaki disease with renal manifestation in a 14 year old adolescent. Apart from the principal features of KD comprising of high grade fever, non purulent conjunctivitis, polymorphous rash, right sided cervical lymphadenitis and symmetrical desquamative lesions of the digits of the hands and feet; our patient also had renal involvement. The renal manifestations included mild periorbital edema, oliguria, hypertension (140/90mmHg), hematuria(++), proteinuria(++) and elevated serum urea and creatinine (8.3mmol/L and 1.9mg/dl respectively). He was managed with high dose aspirin at 80mg/kg/day. The dose was reduced (5mg/Kg/day) and subsequently stopped after serial echocardiography showed normal coronary arteries. Intravenous immune globuline (IVIG) could not be started due to non availability. Nevertheless, clinical signs resolved, renal function normalised after 6 weeks and echocardiographic picture did not deteriorate. Patient is currently on follow up at the paediatric cardiology clinic of UDUTH, Sokoto, Nigeria.. Conclusion: Kawasaki disease can occur even in older children and renal manifestation may be self limiting. This report highlights the need for high index of suspicion in all cases.

Pattern of acquired heart diseases among children seen in Sokoto, North‑Western Nigeria

“…While one of the patients was within the at-risk-age-group, the other patient was diagnosed at an atypical age of 14 years. [25] The latter case further confirmed the fact that KD can occur even in older age groups. [26] A significant observation in this study is that all the patients with EMF were boys, which is similar to findings from a recent study in Nigeria.…”

“…As previously highlighted, the only two cases of KD in this study included an unusual case in a 14-year-old boy that was the first reported case from our center; [25] and a second case in a 2.5-year-old boy who had all the features of KD in association with abnormal hematologic profile and right coronary artery aneurysm. It has been shown that coronary artery abnormalities occurs in 25% of patients with KD and is the most serious sequale that can result in significant morbidity and mortality.…”

Reactivation of BCG scar as a useful tool in the diagnosis of Kawasaki’s disease: A case report

“…In this present case, bilateral redness of the eyes, redness of tongue, a swelling on the cervical region (possibly lymphadenopathy) and desquamation of the skin around the perianal region had disappeared prior to presentation. The manifestation of periungual desquamation later on admission is also in keeping with reported sequential manifestation of symptoms that can occur in Kawasaki disease (6) (Figure 3). …”

“…Kawasaki disease, especially the non-classical form, poses a diagnostic dilemma and at times, not all clinical features required to make the diagnosis are present at the same time (6). In this present case, bilateral redness of the eyes, redness of tongue, a swelling on the cervical region (possibly lymphadenopathy) and desquamation of the skin around the perianal region had disappeared prior to presentation.…”

Vasculitis in Africa

“…Coronary artery abnormality (CAA) was observed in three out of their eight patients or 37.5% of cases [ 22 ]. There have also been a few other patients with KD in Sub-Saharan Africa reported, notably from Ghana [ 23 ], Nigeria [ 24 , 25 ], and Madagascar [ 26 ].…”