Incomplete Kawasaki syndrome followed by systemic onset-juvenile idiopathic arthritis mimicking Kawasaki syndrome

Abstract

A 3-month-old child was first treated for incomplete Kawasaki syndrome with three cycles of intravenous immunoglobulins and aspirin, then with methylprednisolone which led to fever remission. The same child was re-hospitalized after a 10-month-period of well-being for the suspicion of a new episode of Kawasaki syndrome, which appeared to be immunoglobulin-resistant: extensive testing failed to provide an alternative diagnosis of any infectious or infiltrative disease. Diagnosis of systemic onset-juvenile idiopathic arthritis was postulated upon the long persistence of fever and inflammatory signs, which subsided only after starting corticosteroid treatment.

Arthritis in Kawasaki disease: A poorly recognised manifestation

“…In the pre‐IVIG era, early‐onset polyarthritis was more common; it developed during the first 10 days of illness and tended to involve multiple joints, including small and large weight‐bearing joints . This type of arthritis is often undistinguishable from systemic juvenile idiopathic arthritis . Late‐onset arthritis (sub‐acute stage) occurs after the 10th day of illness and is mainly oligoarticular, involving large weight‐bearing joints .…”

“…It has been suggested that arthritis in KD might lead to a worse outcome because it indicates a more intense inflammatory response, accounting for some of the first‐line therapy resistance . However, Gong et al .…”

Arthritis associated with Kawasaki disease: MRI findings and serum matrix metalloproteinase‐3 profiles

“…Arthritis or arthralgia complicates up to one‐third of KD patients and has been divided into two types 1–3 . Early onset arthritis, which develops during the first 10 days of illness, affects both small and large joints and is often indistinguishable from systemic juvenile idiopathic arthritis (JIA) 3,4 . Late‐onset arthritis, which develops on the 10th day or later of illness, primarily affects weight‐bearing joints, similar to oligoarticular JIA, and lasts for 6–8 weeks 2–6 .…”

Delayed diagnosis of Kawasaki syndrome and thrombosis of a medium-sized aneurysm of the anterior descending coronary artery: case report and literature review

“…Though extremely rare, an ascending aortic aneurysm with extensive anterior myocardial infarction and a large pseudoaneurysm of the LDA requiring a coronary arterial bypass were, respectively, described in a 12-and 16-year-old patient with Behçet's disease [24,25]. Also, systemic-onset juvenile idiopathic arthritis with or without macrophage activation can mimic an incomplete KS and show coronary artery dilatation, which should erroneously lean toward KS diagnosis [26][27][28].…”