Incomplete Kawasaki disease with coronary artery involvement |
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| Authors: | A H Rowley F Gonzalez-Crussi S S Gidding C E Duffy S T Shulman |
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| Affiliation: | 1. Department of Pediatrics Northwestern University Medical School, The Children''s Memorial Hospital, Chicago, USA;2. Department of Pathology, Northwestern University Medical School, The Children''s Memorial Hospital, Chicago, USA;1. Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, Galveston, Texas, USA;2. Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas, USA;1. School of Pharmacy, Jinan University, 601 Huangpu Avenue West, Guangzhou 510632, PR China;2. Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;3. Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA;4. Departments of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;5. Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;1. Department of Neonatology, Shikoku Medical Center for Children and Adults, Japan;2. Division of Neonatology, Tokyo Metropolitan Children''s Medical Center, Japan;3. Clinical Laboratory Sciences, Shikoku Medical Center for Children and Adults, Japan;4. Medical Mycology Research Center, Chiba University, Japan;1. College of Public Health, Medical and Veterinary Sciences, The James Cook University, Townsville, Queensland, Australia;2. Department of Medical Imaging, The Townsville Hospital, Douglas, Queensland, Australia;3. Department of Neonatology, The Townsville Hospital, Douglas, Queensland, Australia;4. Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle, Callaghan, New South Wales, Australia;1. Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran;2. Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran;3. Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran;4. Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran;5. Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran;6. Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex, BN1 9PH, UK;1. Department of Pediatrics, National Taiwan University Children''s Hospital and National Taiwan University College of Medicine, Taipei, Taiwan;2. Department of Pediatrics, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan;3. Department of Obstetrics/Gynecology, National Taiwan University College of Medicine, Taipei, Taiwan;4. School and Graduate Institute of Physical Therapy, National Taiwan University College of Medicine, Taipei, Taiwan;5. Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan;6. Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan;7. Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan |
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| Abstract: | ![]()
We report four patients with Kawasaki disease in whom characteristic coronary artery abnormalities developed after illnesses that did not meet diagnostic criteria. An additional patient lacked a history of acute manifestations of Kawasaki disease, but severe Kawasaki-like arterial changes were noted at autopsy. Fever was present in four of the five patients, in three lasting from 7 to 14 days. Despite manifestation of few classic acute clinical features of Kawasaki disease, three of four patients had desquamation of the fingers and toes 10 to 14 days after onset of illness, and the fifth had desquamation several months prior to death. These patients were seen over a 2-year period during which 22 other children were seen with Kawasaki disease with coronary artery abnormalities. Thus, strict adherence to currently accepted criteria for diagnosis of Kawasaki disease may lead to failure to recognize incomplete forms of this illness, with potential sequelae of myocardial infarction or sudden death. This finding suggests that children with prolonged unexplained febrile illnesses, especially those associated with subsequent peripheral desquamation, should undergo echocardiography 3 to 4 weeks after onset of the illness. This practice would help to identify those patients with illnesses characterized by incomplete diagnostic criteria but in whom significant coronary abnormalities develop. |
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