Kawasaki Disease: Highlighting Importance of Laboratory Criteria and Minor Atypical Features of This Enigmatic Entity- A Case Series

@#Introduction: Kawasaki disease (KD) is an acute febrile illness of unknown etiology that primarily affects children younger than 5 years of age. The diagnosis is predominantly clinical and at times difficult, due to the absence of any confirmatory and specific diagnostic test. Early diagnosis of this disease is of paramount importance due to long term cardiovascular complications related to coronary artery aneurysm. Literature search has revealed many atypical presentations of Kawasaki disease not fulfilling the clinical diagnostic criteria. The reason for this could be the diversity in clinical manifestations involving gastrointestinal, endocrinal, musculoskeletal and nervous system. Case Series: Here we describe three cases with non-classic presentation of Kawasaki disease. These three cases presented with persistent fever unresponsive to antibiotics. Two cases (case one and three) later developed perianal rash and peeling that helped in early diagnosis. In the remaining case (case two) sequential appearance of features helped in the establishment of diagnosis. It was interesting to note that all the three cases were having identical laboratory parameters, highlighting the importance of laboratory investigations in case of atypical presentation. Conclusion: This case series culminates the importance of keeping the possibility of atypical Kawasaki disease (KD) as one of the differentials in patients with prolonged fever not responding to antibiotics, in the absence of classical diagnostic criteria.

Outcome of long standing ulno-humeral dislocation managed by open reduction and stabilization with v-y plasty; our experience

Objective: to assess the outcome of long standing ulno-humeral dislocation managed by open reduction and stabilization with V-Y plasty

Methodology: this prospective cross sectional study included 14 patients with elbow dislocation that was more than 3 months without joint ankylosis, myositis ossificans or nerve injury. The surgical management not only included open reduction of the elbow joint, but also elongation of the triceps aponeurosis, collateral ligament repair along with the stabilization of the elbow joint. The results were analyzed using the Mayo Elbow score and the range of motion at 3 months and results were compared with the function of the patients elbows before surgery

Results: among the 14 included patients, there were 9 men and 5 women. The mean age of the patients was 27.8+/-8.3 years. The average ROM Increased from 37.0degree+/-25.8degree to 99.7degree+/-23.3degree of flexion in the postop followup. Whereas the extension lag changed from 15.5degree+/-14.6degree to 19.6degree+/-18.3degree . The mean Mayo score increased from 47 in the preop period to 87 in the postop period

Conclusion: this study demonstrates that relative good function with a pretty low risk can be obtained when comparing the functional results after 3 months with preoperative status. Based on these results we recommend that neglected elbow dislocation should be managed by surgical intervention even if the dislocations are old