[Diagnostic difficulties of the atypical onset of Kawasaki disease: a 8 cases report]

Kawasaki's disease is a multisystemic vasculitis that most often affects young children. It is known for inducing adverse cardiac effects, especially the development of coronary aneurysms that could lead to death. The diagnosis is based only on clinical criteria, and needs the presence of typical fever and 4 out of the 5 other clinical criteria. The aim of this study is to highlight the occurrence of atypical onset of the disease that should in no way delay the diagnosis and the start of treatment. We reviewed 13 cases of Kawasaki disease treated at Pediatrics 3 in Children Hospital of Casablanca from 1996 to 2002: 8 had atypical Kawasaki disease with particular clinical onset or biological parameters and/or evolution, that initially led to other diagnosis. The clinical onset manifestations included one case of uveitis with blindness, another case of febrile purpura, the third case with pyretic hepatomegaly and liver cytolysis. A diffuse cervical lymph node enlargement was described in one case and led to the diagnosis of haemopathy. Two patients had neurological involvement, in one case with ataxia in the other with headache and strabismus. A 12 year-old child had polyarthritis and the diagnosis was made retrospectively and the evolution was sub acute. The last patient had respiratory manifestations with coughing, fever and radiological atelectasia. The risk of coronary aneurysms directs to suspect early Kawasaki disease in very young children with persistent fever and inflammatory patterns, even in the absence of all typical manifestations