ABSTRACT
Objetivo: a doença de Kawasaki é uma vasculite sistêmica aguda autolimitada que acomete vasos de médio e pequeno calibres, preferencialmente as artérias coronárias. Os pacientes que não apresentam todos os critérios necessários para o diagnóstico são classificados como portadores da forma incompleta. Este trabalho descreve criança com a forma incompleta da doença de Kawasaki, ressaltando os aspectos clínicos e laboratoriais que possam ser de auxílio no diagnóstico da doença. Descrição do caso: paciente masculino, seis anos de idade, com febre, mialgia e sinais meníngeos admitido no hospital com diagnóstico de meningite. Apresentava hiperemia conjuntival bilateral ehemorragia conjuntival. A punção lombar evidenciou pleocitose e elevação da proteinorraquia. Iniciado tratamento para meningoencefalite, com desaparecimento da febre e dos sinais meníngeos. No terceiro dia de internação manifestou insuficiência cardíaca e quatro dias após a febre ressurgiu, persistindo por sete dias. A pesquisa de foco infecciosoera negativa. Após a defervescência da febre, o ecocardiograma revelou coronárias dilatadas. Diagnosticada a síndrome de Kawasaki incompleta. No mesmo dia, foi observada descamação laminar nas pontas dos dedos das mãos. Discussão: a síndrome de Kawasaki incompleta deve ser considerada em toda criança com febre prolongada por mais de cinco dias sem foco aparente, associado a algumas das principais manifestações típicas. O diagnóstico tardio representa alto risco de coronariopatias.
Objectives: Kawasaki disease is an acute self-limiting systemic vasculitis that affects medium and small caliber vessels, preferably the coronary arteries. Patients who do not present all the necessary criteria for diagnosis are classified as bearers of the incomplete form. This study describes a child with the incomplete form of Kawasaki disease emphasizing the clinical and laboratory aspects that may be of aid in the disease diagnosis. Case description: male patient, six years old, with fever, myalgia, and meningeal signs admitted to the hospital with a diagnosis of meningitis. He presented bilateral conjunctival hyperemia and conjunctival hemorrhage. The spinal tap showed pleocytosis and elevated proteinorachy. Started treatment for meningoencephalitis, with the disappearance of fever and meningeal signs. On the third day of hospitalization expressed heart failure, and the fever reemerged four days after persisting for seven days. The research of infection was negative. After fever defervescence, the echocardiogram revealed dilated coronary. The incomplete Kawasaki syndrome was diagnosed. On the same day, laminar desquamation was observed at fingertips. Discussion: the incomplete Kawasaki syndrome should be considered in every child with prolonged fever for more than five days without apparent focus, associated with some of the main typical manifestations. The late diagnosis represents higher risk for coronary artery disease.
ABSTRACT
We describe a case of recurrent Kawasaki disease (KD) in a non-Asian 6-year-old boy who had been diagnosed with typical KD without cardiac involvement at age 3 years. He was admitted to the PICU 3 years later for heart failure, hypotension, and deterioration of his general condition. Ultrasonography revealed left ventricular dysfunction with a 44% ejection fraction and grade I mitral valve failure without coronary artery involvement. Subsequent observation of hyperemic conjunctiva, bilateral cervical adenopathies with erythematous skin (normal neck ultrasound and computed axial tomography findings), peeling of the fingertips at day 8 of the illness, and occurrence of an inflammatory syndrome led to a diagnosis of incomplete recurrent KD with a clinical picture of Kawasaki shock syndrome (KSS). Clinical improvement was rapidly obtained after intravenous immunoglobulin and intravenous corticosteroid therapy (30 mg/kg per day for 3 subsequent days). Left ventricular function gradually improved, with ultrasound returning to normal after 3 months. Diagnosis was difficult to establish because of the recurrence of the disease and the incomplete clinical picture, with clinical features of KSS. Physicians need to be aware of these pitfalls in the management of patients with clinical signs of KD.
Subject(s)
Heart Failure/diagnosis , Hypotension/diagnosis , Mucocutaneous Lymph Node Syndrome/diagnosis , Shock/diagnosis , Aspirin/administration & dosage , Child , Combined Modality Therapy , Diagnosis, Differential , Dose-Response Relationship, Drug , Drug Administration Schedule , Echocardiography , Heart Failure/therapy , Humans , Hypotension/therapy , Immunization, Passive , Inflammation Mediators/blood , Intensive Care Units, Pediatric , Male , Methylprednisolone/administration & dosage , Mucocutaneous Lymph Node Syndrome/therapy , Recurrence , Shock/therapyABSTRACT
Objective To explore the clinical value of dynamic electrocardiogram ( DCG) in the diagnosis of coronary artery damage (CAD) in children with Kawasaki disease (KD).Methods A total of 125 cases of children with KD admitted to hospital in recent years was analyzed , without CAD as the control group (83cases), and others as the experimental group (42cases).All cases were undertaken DCG and electrocardiogram (ECG).The results of heart rate, heart Rhythm, and voltage changes were compared be-tween two groups .Results The abnormal rate of total ECG and DCG in the control group was significantly lower than the experimental group ( P 0.05 ) , but DCG abnormal rate of experimental group was significantly lower than ECG (χ2 =15.30, P 0.05 ) .Conclusions DCG test provides scientific parameter in the diagnosis of CAD in children with KD , and is superior to normal ECG , but the value of Joint is the same .
