Kawasaki disease: characteristics, diagnosis, and unusual presentations

Jindal, Ankur Kumar; Pilania, Rakesh Kumar; Prithvi, Ashwini; Guleria, Sandesh; Singh, Surjit

doi:10.1080/1744666x.2019.1659726

Cited by 43 publications

(39 citation statements)

References 187 publications

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“…The diagnosis of KD is always based on clinical criteria and there is no laboratory marker that can serve as a gold standard for diagnosis of this condition (21). A significant proportion of children with KD (25-50% in various series) have incomplete KD (7,(22)(23)(24)(25). And this proportion would be higher in situations wherein the patients have reported late for diagnosis, as was the case in the present series (12,13).…”

Section: Discussionmentioning

confidence: 64%

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CT Coronary Angiography Studies After a Mean Follow-up of 3.8 Years in Children With Kawasaki Disease and Spontaneous Defervescence

et al. 2020

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Background: There is paucity of literature on follow-up of children with Kawasaki disease (KD) who have spontaneous defervescence during the acute stage and do not receive intravenous immunoglobulin. We report herein the role of computed tomography coronary angiography (CTCA) as an imaging modality in such situations. Methods: This prospective observational study was carried out during the period January 2016-June 2017. Children underwent CTCA on 128-slice Dual Source CT (DSCT) scanner (Somatom Definition Flash, Siemens; Germany), and 2D-echocardiography on the same day. Results: Mean age at time of diagnosis was 6.52 ± 3.13 years; range 2-14 years. Mean age at time of study was 11.03 ± 5.10 years; range 3.75-23.30 years. Mean interval between diagnosis of KD and time of present study was 3.84 ± 2.27 years. None of the patients showed any coronary artery abnormalities on either 2D-echocardiography or CTCA. While assessment of proximal segments of left main coronary artery, proximal right coronary artery, and left anterior descending artery was comparable on both 2D-echocardiography and CTCA, left circumflex artery, and distal right coronary artery could be clearly visualized only on CTCA. Conclusion: In our experience, patients with KD who have spontaneous defervescence during the acute stage and do not receive IVIg may not have significant long-term coronary sequelae. CTCA is a useful imaging modality for delineation of coronary artery in patients with KD on long term follow-up especially in older children with thick chest walls and poor acoustic windows.

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Section: Discussionmentioning

confidence: 64%

“…Coronary artery abnormalities (CAAs) are known to develop in 15-25% of children with KD who do not receive appropriate and prompt treatment with IVIg. CAAs account for most of the morbidity and mortality associated with the disease (1,(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

CT Coronary Angiography Studies After a Mean Follow-up of 3.8 Years in Children With Kawasaki Disease and Spontaneous Defervescence

et al. 2020

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“…1 The diagnostic criteria are fever persisting at least 5 days and 4 of the following: Up to half of the patients with KD may present without meeting all the diagnostic criteria; these cases, termed "incomplete" or "atypical" KD, carry the same risk of coronary artery disease as the complete form. 3 Historically, incomplete KD and atypical KD were used interchangeably. However, they are now considered 2 separate entities.…”

Section: Discussionmentioning

confidence: 99%

Unexplained Direct Hyperbilirubinemia and New-Onset Shock in a 17-Year-Old Male

Henry

Horton

Ang

2020

Global Pediatric Health

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A 17-year-old African American male with a past medical history of depression was transferred from an outside hospital with a 3-day history of nonbilious, nonbloody vomiting and new-onset erythematous blanching macular rash on the trunk, arms, and legs. In the emergency department, the patient was tachycardic (134 beats per minute), hypertensive (142/98 mm Hg), and febrile with a temperature of 38.5°C. Four hours later, he became hypotensive (90/60 mm Hg) and remained tachycardic. Due to concerns of septic shock, blood cultures were drawn, and the patient was started on empiric antibiotic treatment. After admission to the hospital, subsequent workup demonstrated hyponatremia (135 mMol/L), direct hyperbilirubinemia (6.18 mg/dL), low lactate dehydrogenase (111 units/L), polymorphic neutrophil dominant leukocytosis (12 800/mm 3), elevated C-reactive protein (99.3 mg/L), and sterile pyuria.

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“…However, autopsy studies later revealed the coronary artery complications associated with KD ( 4 ). Over time, it has now been realized that KD may cause several other cardiac complications as well ( 5 , 6 ) ( Table 1 ). It has been shown that myocarditis in KD is, in fact, more common than coronary artery involvement and may be almost universal ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Involvement in Kawasaki Disease Is Much More Than Mere Coronary Arteritis

et al. 2020

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Kawasaki disease (KD) is now a common cause of acquired heart disease in children. Coronary artery involvement is the most serious complication in children with KD. Several non-coronary complications have now been identified in this condition but these are often overlooked. Myocarditis is an integral component of KD and may be more common than coronary artery abnormalities. Pericardial involvement and valvular abnormalities have also been observed in patients with KD. KD shock syndrome is now being increasingly recognized and may be difficult to differentiate clinically from toxic shock syndrome. Endothelial dysfunction has been reported both during acute stage and also on follow-up. This may be a potentially modifiable cardiovascular risk factor.

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Kawasaki disease: characteristics, diagnosis, and unusual presentations

Cited by 43 publications

References 187 publications

CT Coronary Angiography Studies After a Mean Follow-up of 3.8 Years in Children With Kawasaki Disease and Spontaneous Defervescence

CT Coronary Angiography Studies After a Mean Follow-up of 3.8 Years in Children With Kawasaki Disease and Spontaneous Defervescence

Unexplained Direct Hyperbilirubinemia and New-Onset Shock in a 17-Year-Old Male

Cardiovascular Involvement in Kawasaki Disease Is Much More Than Mere Coronary Arteritis

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