Very high serum ferritin levels in three newborns with Kawasaki-like illness

Nasir, Arwa; Tatari, Hosam Al; Hamdan, Mohamed A.

doi:10.1093/pch/17.4.201

Cited by 14 publications

(9 citation statements)

References 18 publications

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“…Of the 12 patients with fewer than 4 of 5 KD criteria, 6 infants, including our case, had fever with 2 or 3 criteria, and either CAA, or typical desquamation or thrombocytosis in the sub-acute phase, as well as resolution of symptoms following IVIG therapy. Three patients presented with 3–4 days of fever and 3 criteria, including striking extremity edema and erythema, and had rapid resolution of all symptoms with IVIG treatment at 3–4 days, despite not meeting KD criteria [ 12 ]. Three patients with suspected neonatal KD presented within the first 1–5 days of life with CAA suggestive of KD without prolonged fever or other principal criteria.…”

Section: Discussionmentioning

confidence: 99%

Kawasaki Disease in the neonate: case report and literature review

Altammar

Lang

2018

Pediatr Rheumatol

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BackgroundKawasaki Disease (KD), the leading cause of acquired heart disease in children in the developed world, is extremely rare in neonates. We present a case of incomplete KD in a neonate and a review of the literature on neonatal KD.Case presentationA previously healthy full term 15 day old Caucasian male with an unremarkable antenatal and perinatal history, presented on Day 2 of illness with fever, rash, irritability, and poor feeding. Examination revealed fever (39.6C), tachycardia, tachypnea, extreme irritability, and a generalized maculopapular rash, but was otherwise normal. His complete blood count, CRP and ESR were normal. Empiric intravenous antibiotics and acyclovir resulted in no improvement. On day 4, he had ongoing fever and developed recurrent apnea, required supplemental oxygen, and was transferred to the pediatric intensive care unit. On day 6, he developed bilateral non-purulent conjunctivitis, palmar erythema, bilateral non-pitting edema and erythema of his feet, and arthritis. His full septic work-up and viral studies were negative. On Day 7 he was treated with intravenous immunoglobulin, and over the next 48 h his symptoms including extremity edema resolved, he no longer required supplemental oxygen, and fever did not recur. On day 9 of illness he had marked thrombocytosis. Subsequently, he developed distal extremity desquamation. Repeated echocardiograms excluded the presence of coronary artery aneurysms (CAA).ConclusionsWe believe this to be a rare case of incomplete KD in a neonate, in which timely IVIG administration led to resolution of the acute illness and may have prevented CAA. A comprehensive English-language medical literature review of KD presenting in the neonatal period revealed only fifteen case reports. Cases often presented with incomplete KD, and a number had atypical laboratory features including a normal CRP in the acute phase, similar to what was seen in our patient. This case and our literature review should increase awareness that KD can rarely occur in neonates, often presenting atypically. Recognizing KD in a neonate enables appropriate treatment that can result in resolution of symptoms and may decrease the risk of cardiac complications.

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Section: Discussionmentioning

confidence: 99%

Kawasaki Disease in the neonate: case report and literature review

Altammar

Lang

2018

Pediatr Rheumatol

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“…Both KD and MIS-C are associated with a significant cytokine storm that results in systemic inflammation and may explain the myocardial dysfunction that is often seen in these patients [8,40,87]. In addition, elevated level of ferritin in these patients is a surrogate marker for MAS [88]. It has been noted that high levels of ferritin are associated with severe disease in SARS-CoV-2-associated MIS-C [8].…”

Section: Similarities Between Mis-c and Kdmentioning

confidence: 99%

Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management

et al. 2020

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Multisystem inflammatory syndrome (MIS-C) is a pediatric hyperinflammation disorder caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It has now been reported from several countries the world over. Some of the clinical manifestations of MIS-C mimic Kawasaki disease (KD) shock syndrome. MIS-C develops 4-6 weeks following SARS-CoV-2 infection, and is presumably initiated by adaptive immune response. Though it has multisystem involvement, it is the cardiovascular manifestations that are most prominent. High titres of anti-SARS-CoV-2 antibodies are seen in these patients. As this is a new disease entity, its immunopathogenesis is not fully elucidated. Whether it has some overlap with KD is still unclear. Current treatment guidelines recommend use of intravenous immunoglobulin and high-dose corticosteroids as first-line treatment. Mortality rates of MIS-C are lower compared to adult forms of severe COVID-19 disease. Keywords Multisystem inflammatory syndrome (MIS-C) • Kawasaki disease (KD) • Hyperinflammation • Coronavirus disease 2019 • Kawasaki-like disease Background Kawasaki disease (KD) is a medium vessel vasculitis of undetermined etiology usually affecting children below 5 years [1-3]. Rowley et al. had hypothesized as far back as 2004 that an unidentified respiratory infectious agent with tropism to vascular tissue, likely a virus, could be linked to the etiology of KD [4]. This putative RNA virus, presumably a ubiquitous one, resulted in persistent infection in bronchial epithelium and macrophages and was associated with intracytoplasmic inclusions [5, 6]. Rheumatology INTERNATIONAL Jayakanthan Kabeerdoss and Rakesh Kumar Pilania are the joint first authors and they contributed equally. Disclaimer We hereby state that this manuscript is original and no part of the manuscript has either been published before, or is under consideration of publication elsewhere. The definition of scientific term alluded to, in the manuscript have been duly cited.

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“…Our literature search revealed only a few reported cases of suspected NKD worldwide (18 cases, including 14 English literature and 4 Chinese literature) (Table 1) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], together with this case, 19 cases in total. In all the presented cases including ours, 12 were male and 7 were female, the age of onset was 1-26 days.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Kawasaki Disease: Case Report and Literature Review

Wang

et al. 2020

Preprint

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Background: Kawasaki Disease (KD) is a self-limiting and acute systemic vasculitis of childhood that leads to coronary artery abnormality in about 25% of untreated cases. KD is extremely rare in neonates. The purpose of this paper is to explore the clinical features and diagnosis and treatment of Neonatal Kawasaki Disease (NKD) for early identification. Case presentation: A boy was a 24-day-old full-term infant with no special birth history. He had fever, irritability and rash at the time of admission. After 4 days of treatment with empirical antibiotics, the rash and fever were still present, and the rash was progressively increased. It is considered that the infection was serious, and antibiotics were changed and given intravenous immunoglobulin. The temperature and rash were better than before. On day 5, he had cracking of lips, on day 9, he had lymph node enlargement in the neck, and molted fingers appeared on the 10th day. Thus the complete Kawasaki Disease (CKD) was diagnosed, and the patient was given intravenous immunoglobulin (IVIG) and aspirin. Within 48h after the start of this therapy, the fever declined, the chapped lips got better, the rash resolved, and distal extremity desquamation appeared. On day 5, 13, and 18, there was no abnormality in echocardiography and no coronary dilatation. On day 20, the chapped lips and the distal extremity desquamation got better. After discharge, the patient continued to take aspirin orally. The patient was followed up to 1 year old, with good prognosis and no carditis or coronary artery abnormalities. Our literature search revealed only a few reported cases of suspected NKD worldwide (18 cases, including 14 English literature and 4 Chinese literature) (Table 1), together with this case, 19 cases in total. Among these 19 cases, 12 were male and 7 were female, the age of onset was 1-26 days. Six patients had complete KD (31.5%), 13 patients were IKD. Clinical manifestations: there were 17 cases of fever (89.5%, 13cases of fever >5days), 13cases (68.4%) of early limb edema/swelling or peeling, 16 cases (84.2%)of skin rash, 14cases (73.7%)of oral mucosal changes (lips red/cleft or strawberry tongue), 10 cases (53%) of coronary artery changes, 7cases (36.8%) of conjunctival congestion, 3cases（15.8%）of cervical lymph node enlargement. Laboratory investigations: There were 5 cases (35.7%) with elevated ESR, 9 cases normal, 5cases unknown. CRP was normal in 6 cases (33%). Thrombocytopenia occurred in 11cases (64.7%). Among the 10 patients with coronary artery changes, 1 had an unknown prognosis due to loss of follow-up (patient 15). One patient died 2 days after discharge due to multiple organ failure (patient 17). 4 cases returned to normal (patient 3.6.7.14). The coronary artery changes in 4 cases still did not return to normal and were not followed up for a long time. Of the 19 NKD patients, 16 were sensitive to IVIG, 1did not use IVIG, and 1 was not sensitive to IVIG，and due to multiple organ failure, the parents gave up treatment and died two days after discharge.Conclusion: NKD is extremely rare, and its clinical manifestation is not typical and easy to be missed. If not treated early, it will potentially give rise to coronary artery aneurysms or expansion, ischemic heart disease, and sudden death. Early diagnosis and treatment are very important.

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Very high serum ferritin levels in three newborns with Kawasaki-like illness

Cited by 14 publications

References 18 publications

Kawasaki Disease in the neonate: case report and literature review

Kawasaki Disease in the neonate: case report and literature review

Severe COVID-19, multisystem inflammatory syndrome in children, and Kawasaki disease: immunological mechanisms, clinical manifestations and management

Neonatal Kawasaki Disease: Case Report and Literature Review

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