Kawasaki disease shock syndrome: A report of two cases and literature review

Abstract

Importance Kawasaki disease shock syndrome (KDSS) is a rare Kawasaki disease (KD) manifestation. The pediatricians are not aware of the full range of clinical characteristics of KDSS. Objective We aimed to investigate the clinical features, diagnosis and treatment of KDSS in two patients and we included a literature review. Methods We collected and analyzed the clinical data for two patients with KDSS. Additionally, using “Kawasaki diseases shock syndrome” as a key phrase, we searched PubMed, Biotechnology Information and Wanfang Data Knowledge Service Platform databases for any similar reports between January 2009 and March 2017. Results Both of our patients diagnosed with KD developed sustained hypotension during the course of intravenous immunoglobulin treatment, as well as hypoalbuminemia, and increased C‐reactive protein and brain natriuretic peptide levels during hypotension. Both patients responded well to fluid resuscitation and inotropic support. No aneurysms formed in either patient during follow‐up. We reviewed two related studies in Chinese and 11 studies in English. Interpretation KD may present with severe shock, and requires proper diagnosis and rapid treatment. The prognosis for most patients with KDSS is excellent.

Comparison of Clinical Features and Inflammatory Markers between Kawasaki Disease Shock Syndrome and Kawasaki Disease without Shock: A Meta-Analysis

“…In 1975, Kato et al [6] reported a case of severe complications such as shock and heart failure in a 6-monthold child with KD. Since then, this critically ill KD with hemodynamic changes has been reported by successive investigators [7][8][9][10][11]. In 2009, Kanegaye et al [12] first formally defined hemodynamically unstable Kawasaki disease as Kawasaki disease shock syndrome (KDSS), which accounts for approximately (1.9∼7.0)% of all KD.…”

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

“…These patients are often misdiagnosed as toxic shock syndrome (TSS) and this led to delays in institution of appropriate therapy (66,67). KDSS is usually seen in older children and is more commonly reported in boys (66,68,69), although some studies have also noted a female predominance (70). Some authorities believe that KDSS may, in fact, be a unique subtype of KD (65).…”