Clinical features of recurrent Kawasaki disease and its risk factors

Yang, Hongxiao; Du, Zhenhong; Fu, Peipei

doi:10.1007/s00431-013-2101-9

Cited by 36 publications

(43 citation statements)

References 24 publications

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“…The disease seems to recur more frequently in the first 2 years after diagnosis, with the highest rates between the ages of 1 and 2 years, and with a lower risk in children aged $3 years at initial onset. 5,6,11,12 In our case, the clinical presentation was incomplete, with, in particular, a febrile episode lasting only 4 days. In the case of recurrent KD, the fever duration has been reported to be shorter, 13,14 but overall clinical features and response to IGIV are comparable in single-episode and recurrent KD.…”

Section: Discussionmentioning

confidence: 97%

“…In the case of recurrent KD, the fever duration has been reported to be shorter, 13,14 but overall clinical features and response to IGIV are comparable in single-episode and recurrent KD. 12,15 Whether recurrent KD has more coronary sequelae is not clear. 12,15,16,17 Taken together, these data do not reveal any salient differences in clinical features between single-attack and recurrence of KD.…”

Section: Discussionmentioning

confidence: 99%

“…12,15 Whether recurrent KD has more coronary sequelae is not clear. 12,15,16,17 Taken together, these data do not reveal any salient differences in clinical features between single-attack and recurrence of KD. The recurrence of KD seems to be a repetition of the same self-limited inflammatory process in persons genetically prone to developing the disease.…”

Section: Discussionmentioning

confidence: 99%

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Kawasaki Shock Syndrome Complicating a Recurrence of Kawasaki Disease

et al. 2014

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We describe a case of recurrent Kawasaki disease (KD) in a non-Asian 6-year-old boy who had been diagnosed with typical KD without cardiac involvement at age 3 years. He was admitted to the PICU 3 years later for heart failure, hypotension, and deterioration of his general condition. Ultrasonography revealed left ventricular dysfunction with a 44% ejection fraction and grade I mitral valve failure without coronary artery involvement. Subsequent observation of hyperemic conjunctiva, bilateral cervical adenopathies with erythematous skin (normal neck ultrasound and computed axial tomography findings), peeling of the fingertips at day 8 of the illness, and occurrence of an inflammatory syndrome led to a diagnosis of incomplete recurrent KD with a clinical picture of Kawasaki shock syndrome (KSS). Clinical improvement was rapidly obtained after intravenous immunoglobulin and intravenous corticosteroid therapy (30 mg/kg per day for 3 subsequent days). Left ventricular function gradually improved, with ultrasound returning to normal after 3 months. Diagnosis was difficult to establish because of the recurrence of the disease and the incomplete clinical picture, with clinical features of KSS. Physicians need to be aware of these pitfalls in the management of patients with clinical signs of KD. Kawasaki disease (KD) is an acute, selflimited vasculitis. Its origin is still unknown despite intensive research. It affects children, mainly between the ages of 6 months and 5 years. Its diagnosis relies on the compilation of clinical and biological data, because no specific diagnostic test exists. Diagnosis must be made early to avoid coronary involvement, which is the most severe complication of KD. The disease can sometimes display atypical or incomplete clinical pictures that the physician needs to know. Also, the disease is liable to recur many months after a first episode. PATIENT PRESENTATIONAt age 3 years, our patient had developed typical KD (fever .5 days, erythema, cheilitis, conjunctivitis, and cervical adenopathies) with a biological inflammatory syndrome (C-reactive protein [CRP]: 18.3 mg/dL; erythrocyte sedimentation rate: 64 mm). Investigations for infection (throat swab polymerase chain reaction analysis for herpes, blood cultures, and serology for mycoplasmas and herpes virus) were negative. Echocardiography on day 6 was normal (telediastolic left ventricle diameter: 35 mm; shortening fraction: 34%; ejection fraction: 65%; no valvular involvement, no coronary abnormalities, and no pericardial effusion). He was treated with intravenous g-globulin (IVIG; Tegeline; LFB Biomédicaments, Les Ulis, Essonne, France) 2 g/kg on day 5 and acetylsalicylic acid (80 mg/kg per day for 2 weeks and then 3 mg/kg per day for 1 month), and his clinical condition improved rapidly. A diminution of blood pressure occurred during the injection, and was considered to be an anaphylactic reaction. Follow-up echocardiograms at 1 and 3 months were normal.Three years later, he was again admitted to the PICU for clinical signs of he...

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Kawasaki Shock Syndrome Complicating a Recurrence of Kawasaki Disease

et al. 2014

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“…KD is an idiopathic pan‐vasculitic disorder of medium‐sized arteries with most affected patients under 5 years. Children with recurrent KD have significantly higher aspartate aminotransferase and alanine aminotransferase levels than those with single‐episode KD and may be at increased risk for greater hepatic injury …”

Section: Summary Of Liver Function Tests and Clinical Coursementioning

confidence: 99%

Autoimmune sclerosing cholangitis: An atypical association with kawasaki disease

et al. 2016

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“…I excluded 29 patients who received concomitant IVIG and anti-inflammatory therapy, four patients who had developed CAL before the start of therapy, and seven patients with disease recurrence and one patient who developed left ventricular dysfunction because of their greater prevalence of CAL [9,10,11].…”

mentioning

confidence: 99%

Different subgroups regarding the absence of rescue therapy in intravenous immunoglobulin-resistant Kawasaki disease

Nakada¹

2016

IOSRPHR

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:The objective of this study is the description of clinical outcomes regarding the absence of rescue therapy of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease. I investigated the clinical outcomes of 33 IVIG-resistant patients who received the initial single IVIG therapy with the delayed use of antiinflammatory drugs (DUA). These patients were divided into two groups: 11 patients who received rescue therapies (rescue group) and 22 patients who did not receive rescue therapy (non-rescue group). One patient of rescue group developed coronary artery lesions (CAL). None of the patients of non-rescue group developed CAL. The prevalence of persistent fever between rescue and non-rescue groups at 3 days and 4 days after initial IVIG therapy was 100% vs. 77% ( P = 0.144 ) and 100% vs. 18% ( P < 0.001 ), respectively. The C-reactive protein value, neutrophil counts, serum albumin levels, and sodium levels were significantly different between two groups at median 3 days after initial IVIG therapy. Two-thirds of the IVIG-resistant patients diagnosed at 24 h after completion of the initial IVIG therapy with DUA did not develop CAL after 30 days of illness without rescue therapies. The rescue therapy at this time may lead to overtreatment.

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Clinical features of recurrent Kawasaki disease and its risk factors

Cited by 36 publications

References 24 publications

Kawasaki Shock Syndrome Complicating a Recurrence of Kawasaki Disease

Kawasaki Shock Syndrome Complicating a Recurrence of Kawasaki Disease

Autoimmune sclerosing cholangitis: An atypical association with kawasaki disease

Different subgroups regarding the absence of rescue therapy in intravenous immunoglobulin-resistant Kawasaki disease

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