Unusual Presentation of Pustular Eruption in Kawasaki Disease Shock Syndrome: A Case Report

2021 ◽  
Vol 104 (7) ◽  
pp. 1218-1221
Keyword(s):  
Case Report ◽  
Kawasaki Disease ◽  
Artery Aneurysm ◽  
Normocytic Anemia ◽  
High Dose ◽  
Cervical Lymphadenitis ◽  
Pustular Eruption ◽  
Study Case ◽  
Maculopapular Rashes ◽  
High Dose Aspirin

The present study case report described a 46-month-old girl with Kawasaki disease shock syndrome (KDSS) who presented with five days of fevers, unilateral cervical lymphadenitis, pustular eruption, maculopapular rashes, erythema of palms and soles, conjunctivitis, cracked lips, and shock. Laboratory results showed elevated ESR & CRP, leukocytosis, normocytic anemia, and transaminitis. Pustular eruption Gram and Wright stains demonstrated numerous neutrophils. Echocardiogram showed normal results. Fluid resuscitation, broad spectrum antibiotics, inotropic drug, IVIG, and high dose aspirin were given. Diagnosis of Kawasaki disease was supported by clinical and laboratory features at the acute phase, in conjunction with periungual peeling of fingers and toes and thrombocytosis at the subacute phase. The patient made a complete recovery.The present study case showed an unusual pustular eruption in KDSS. Clinicians should consider these presentations to the diagnosis of KDSS and timely prescribed IVIG, to prevent coronary artery aneurysm. Keywords: Pustular eruption; Kawasaki disease shock syndrome

scholarly journals Kawasaki Disease Presenting as Acute Acalculous Cholecystitis

2019 ◽  
Vol 3 (4) ◽  
pp. 383-386 ◽  
Author(s):  
Demis Lipe ◽  
Lindsey Bridges
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Acalculous Cholecystitis ◽  
Acute Acalculous Cholecystitis ◽  
High Dose ◽  
Coronary Artery Aneurysms ◽  
Abdominal Symptoms ◽  
Dose Aspirin ◽  
Serious Disease ◽  
High Dose Aspirin

Acute acalculous cholecystitis (AAC) is a rare, potentially serious disease that has been associated with Kawasaki disease (KD) in children. Studies suggest that patients presenting with severe abdominal symptoms secondary to KD have increased resistance to intravenous immunoglobulin (IVIG), and a higher rate of coronary artery aneurysms. We describe an eight-year-old boy who presented to the emergency department with severe abdominal pain and was diagnosed with AAC and KD. He was treated with IVIG and high-dose aspirin, achieving good response with complete symptom resolution. He had no coronary artery aneurysms or further complications and was discharged after three days.

scholarly journals What dose of aspirin should be used in the initial treatment of Kawasaki disease? A meta-analysis

Rheumatology ◽  
2020 ◽  
Vol 59 (8) ◽  
pp. 1826-1833
Author(s):  
Xinyi Jia ◽  
Xiao Du ◽  
Shuxian Bie ◽  
Xiaobing Li ◽  
Yunguang Bao ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Random Effects ◽  
Initial Treatment ◽  
Low Dose ◽  
Cochrane Library ◽  
High Dose ◽  
Random Effects Model ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
High Dose Aspirin

Abstract Objective The use of IVIG plus high- or low-dose aspirin for the initial treatment of Kawasaki disease remains controversial. The aim of this study was to evaluate the efficacy of IVIG plus high-dose aspirin compared with IVIG plus low-dose aspirin in the treatment of Kawasaki disease. Methods Studies related to aspirin therapy for Kawasaki disease were selected by searching the databases of Medline (PubMed), Embase and the Cochrane Library before March 2019. Statistical analyses were performed by using a Review Manager Software package and STATA v.15.1. Results Eight retrospective cohort studies, characterizing 12 176 patients, were analysed. Overall, no significant difference was found in the incidence of coronary artery abnormalities between the high- and low-dose aspirin groups [relative risk (RR) 1.15; 95% CI: 0.93, 1.43; P = 0.19; random-effects model]. The patients treated with high-dose aspirin had slightly faster resolution of fever [mean difference (MD) −0.30; 95% CI: −0.58, −0.02; P = 0.04; random-effects model]. but the rates of IVIG resistance (RR, 1.26; 95% CI: 0.55, 2.92; P = 0.59; random-effects model) and days in hospital (MD, 0.22; 95% CI: −0.93, 1.37; P = 0.71; random-effects model) were similar between the two groups. Conclusion Low-dose aspirin plus IVIG might be as effective as high-dose aspirin plus IVIG for the initial treatment of Kawasaki disease. Considering that high-dose aspirin may cause more adverse reactions than low-dose aspirin, low-dose aspirin plus IVIG should be recommended as the first-line therapy in the initial treatment of Kawasaki disease.

scholarly journals High-Dose Aspirin Is Associated with Anemia and Does Not Confer Benefit to Disease Outcomes in Kawasaki Disease

PLoS ONE ◽  
2015 ◽  
Vol 10 (12) ◽  
pp. e0144603 ◽  
Author(s):  
Ho-Chang Kuo ◽  
Mao-Hung Lo ◽  
Kai-Sheng Hsieh ◽  
Mindy Ming-Huey Guo ◽  
Ying-Hsien Huang
Keyword(s):  
Kawasaki Disease ◽  
High Dose ◽  
Disease Outcomes ◽  
Dose Aspirin ◽  
High Dose Aspirin

scholarly journals Concomitant Coronary Artery Aneurysm and Myocarditis as a Rare Manifestation of Kawasaki Disease: A Case Report

1970 ◽  
Vol 3 (1) ◽  
pp. 34-36 ◽  
Author(s):  
Aliasghar Halimiasl ◽  
Amir Hossein Hosseini ◽  
Reza Shiari ◽  
Parviz Ghadamli ◽  
Saeed Mojtahedzadeh
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Coronary Artery Aneurysm ◽  
Artery Aneurysm ◽  
Rare Manifestation

Abstract 49: Kawasaki Disease With Tsutsugamushi Disease: A Case Report

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Min Seob Song
Keyword(s):  
Case Report ◽  
Kawasaki Disease ◽  
Influenza A ◽  
Influenza B ◽  
Polymorphonuclear Leucocytes ◽  
Cervical Lymphadenitis ◽  
Presumptive Diagnosis ◽  
Tsutsugamushi Disease ◽  
Mycoplasma Pneumonia ◽  
Number Of Microorganisms

Background : Clinical and epidemiologic features suggest infectious agents as a possible cause of Kawasaki disease; however, the etiology of Kawasaki disease still remains unknown. A number of microorganisms were hypothesized as an etiology of the illness. This is the first reported case of Kawasaki disease with tsutsugamushi disease. Case presentation: We report the case of a 4-year-old boy who presented with fever of 7 days duration and skin rash and bilateral conjunctival injection. He had a history of visiting a rural area with his grandmother. On admission, he had fever of 39.4 °C. His heart rate was 90/minute and his blood pressure was 90/60 mmHg. His pharynx was slightly injected and there was red lip. His neck was swollen with cervical lymphadenitis. He had erythematous macular rash on her trunk. Examination of his skin revealed an eschar on penile base of right scrotum. His laboratory results showed WBC 4,720/mm 3 , 42% polymorphonuclear leucocytes, 39% lymphocytes, hemoglobin 10.3 gm/dL, platelet count 148,000/mm 3 , CRP 3.23mg/dl, pro-BNP 316.5 pg/ml. The respiratory viruses using a multiplex real-time-PCR kit (Adenovirus, Influenza A, Influenza B, Metapneumovirus, Rhino A virus, Respiratory syncytiai virus, Parainfluenza ) were all negative. Mycoplasma pneumonia IgM was negative. R.tsutsugamushi Ab was positive. Echocardiographic findings 1 day after admission was mild dilatation of LCA (RCA=1.8mm, LCA=3mm). He was treated on oral roxithromycin for presumptive diagnosis of tsutsugamushi disease along with clinical features of Kawasaki disease which resolved after therapy with intravenous immune globulin and aspirin. Over the next 48 hours, he became afebrile and his rash improved. He was placed on low-dose aspirin for 8 weeks. His echocardiogram were within normal limit (RCA= 1.9mm, LCA= 2.7mm) at 2 months after the onset of his illness. Conclusion: This case report suggests that Kawasaki disease can rarely occur concurrently or immediately after a rickettsial illness such as tsutsugamushi disease.

scholarly journals Recurrent Kawasaki Disease: A Case Report of Three Separate Episodes at >4-Year Intervals

Children ◽  
2018 ◽  
Vol 5 (11) ◽  
pp. 155 ◽  
Author(s):  
Nikita Goswami ◽  
Katherine Marzan ◽  
Elizabeth De Oliveira ◽  
Sharon Wagner-Lees ◽  
Jacqueline Szmuszkovicz
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Systemic Vasculitis ◽  
High Dose ◽  
Z Score ◽  
Coronary Aneurysms ◽  
Increased Risk ◽  
The Right ◽  
Work Up ◽  
High Dose Aspirin

Kawasaki disease (KD) is a self-limited systemic vasculitis, most often occurring in children 1–5 years old. It has a 2% recurrence rate and is associated with coronary aneurysms (CA), which can develop within two weeks of onset. A 25% increased risk is noted in patients who are recalcitrant to treatment. We describe a patient with recurrence of KD three times, approximately four years apart. A 10-year-old female with two previous episodes of KD, at 11 months and five years of age), in which she met five out of five criteria for KD and had no coronary involvement, presented with 15 days of fever, conjunctivitis and mucocutaneous changes. Infectious work-up was negative, and she was diagnosed with incomplete KD meeting three out of five criteria. An echocardiogram (ECHO) on day 12 revealed dilation of the right coronary artery (RCA) and left coronary artery (LCA). Treatment with intravenous immunoglobulin (IVIG) and high-dose aspirin was started at an outside hospital. After transfer, serial ECHOs showed evolving coronary aneurysms, left anterior descending (LAD) z-score + 8.2 and RCA z-score + 4.0. She received 10 mg/kg infliximab (day 18) and began clopidogrel. A cardiac MRI (day 20) demonstrated progression of the LAD aneurysm, with a z-score + 13, and warfarin was started. To our knowledge, this is the first report of recurrent KD occurring three times at ~5 year intervals.

Concomitant Coronary Artery Aneurysm and Myocarditis as a Rare Manifestation of Kawasaki Disease: A Case Report

1970 ◽  
Vol 3 (1) ◽  
pp. 34-36 ◽  
Author(s):  
Aliasghar Halimiasl ◽  
Amir Hossein Hosseini ◽  
Reza Shiari ◽  
Parviz Ghadamli ◽  
Saeed Mojtahedzadeh
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Coronary Artery Aneurysm ◽  
Artery Aneurysm ◽  
Rare Manifestation
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