Doença de Kawasaki em lactente: relato de caso

Abstract

RESUMORelato de caso de lactente diagnosticada com doença de Kawasaki, vasculite febril que atinge principalmente crianças entre 2 e 3 anos de idade. O agente etiológico é ainda desconhecido, mas a epidemiologia e o quadro clínico sugerem caráter infeccioso. Pode haver envolvimento cardíaco e microaneurismas em coronárias. Os diagnósticos diferenciais são sarampo, adenovírus e artrite reumatoide juvenil. O tratamento é feito com imunoglobulina intravenosa, salicilatos e corticoterapia. A paciente de 13 meses de idade, previamente hígida, apresentou primeiramente quadro de febre alta com rinorreia e congestão ocular, medicada com sintomáticos; três dias após, evoluiu com quadro de hiperemia em face, tronco e membros, novamente tratada com sintomáticos e anti-histamínico. Após dois dias, apresentou edema em face, mãos e pés, hiperemia difusa, exantema oral e febre; foi encaminhada ao hospital e internada para investigação. Apresentava todos os critérios para doença de Kawasaki: febre alta, congestão ocular, alteração em cavidade oral, exantema polimorfo, edema em extremidades e linfadenopatia cervical aguda. Foi medicada com imunoglobulina intravenosa e salicilatos. Após alta hospitalar, cursou com febre, edema e descamação palmoplantar; foi internada e reintroduzida imunoglobulina intravenosa, salicilatos e corticoterapia; evoluiu bem e teve alta em dois dias. Durante sua internação, realizou-se ecocardiograma, que descartou alterações cardíacas. Palavras-chave: síndrome de linfonodos mucocutâneos; vasculite; febre; lactente. ABSTRACTInfant case report diagnosed with Kawasaki disease, a febrile vasculitis that affects mainly children between 2 and 3 years old. The causative agent is still unknown, but the epidemiology and clinical features suggest infectious character. There may be cardiac involvement and micro aneurysms in the coronary arteries. Differential diagnoses are measles, adenovirus and juvenile rheumatoid arthritis. Treatment is with intravenous immunoglobulin, salicylates and steroids. The patient, who is 13 months old, previously healthy, first presented high fever and runny nose eye congestion, treated with symptomatic medication; three days later she evolved with hyperemia frame in the face, trunk and limbs, again treated with symptomatic and antihistamine. After two days, there was swelling in the face, hands and feet, diffuse hyperemia, oral erythema and fever, and she was referred to a hospital for investigation. She presented all the criteria for Kawasaki disease: high fever, eye congestion, alterations in the mouth, polymorph rash, edema in the extremities and acute cervical lymphadenopathy. She was treated with intravenous immuglobulin and salicylates. After leaving hospital, she coursed with fever, swelling and palmoplantar desquamation. She was hospitalized and intravenous immunoglobulin, salicylates and corticosteroids were reintroduced; she progressed well and was discharged in two days. During her hospitalization, the echocardiogram ruled out heart problems. Keywords: mucocutaneous lymph...

Kawasaki Disease, a Clinical Challenge: Literature Review

“…org/pt/kd-symptoms/ Image taken from:https://www.scielo.br/j/abc/a/ MpjpPH6z9wPCYQ38M4w49Ch/?lang=pt# Due to the lack of a specific symptom or laboratory findings, it is difficult to establish a rapid diagnosis, in addition to the fact that the disease can be confused with other febrile childhood illnesses. KD makes the differential diagnosis with viral infectious diseases (infectious mononucleosis, measles, adenovirus, arboviruses) or bacterial (scarlet fever, bacterial cervical adenitis, retropharyngeal abscess) or non-infectious diseases (systemic juvenile idiopathic arthritis, sarcoidosis, systemic lupus erythematosus, hematological neoplasms and reactions to drugs) 12,13 .…”

“…Such criteria described in the literature are: bilateral conjunctival hyperemia, changes in the oropharynx (lip erythema, or cleft lip or erythema in the oropharynx, or raspberry tongue), polymorphic rash, changes in the peripheral extremities (edema of hands or feet, or erythema palm-plantar, or periungual desquamation) and cervical lymphadenopathy (diameter greater than 1.5 cm) 6 . The aforementioned elements are described in the table below: When a case presents with fever for five days or more, associated with at least two of the criteria described above, in addition to laboratory data consistent with systemic inflammatory disease, without any other explanation for the condition, the incomplete form of KD is characterized 12 . KD treatment consists of: immunomodulation with intravenous gammaglobulin (2 g/kg) as the first line; Acetylsalicylic acid (80-100 mg/kg/day) in the febrile phase or while thrombocytosis persists, or if there are coronary aneurysms, being prescribed in the latter two cases in reduced doses (3-5 mg/kg/day).…”