Node-First Kawasaki Disease Presented with Marked Pancarditis: a Case Report

Document Type : Case Report

Authors

1 Associate Professor, Amirkabir Hospital, Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, Iran

2 Amirkabir Hospital, School of Medicine, Arak University of Medical Sciences, Arak, Iran

3 Ph.D. candidate, Department of Biostatistics, Arak University of Medical Sciences, Arak, Iran

Abstract

Kawasaki disease is an acute inflammatory disorder of medium-sized arteries that predominantly affects cardiac coronary arteries and children under the age of 5 years. Cardiac involvement usually happens later than 10 days after the onset of illness. Most of cardiac complications are coronary artery abnormalities (ectasia or aneurysms) and subclinical myocarditis. Clinical myocarditis (symptomatic congestive heart failure), pericarditis, valvulitis and pericardial effusion, as well as pancarditis are rare.
This paper reports a 5-year-old boy who had heart failure (ejection fraction 48%) in the acute stage of Kawasaki disease and pericarditis. He was admitted to the hospital following 3 days of continuous fever, bilateral cervical adenopathy and dominant right side neck of torticollis. The results of physical examination after 5 days showed typical Kawasaki disease. Cardiac examination also revealed cardiac murmur and gallop rhythm. In laboratory tests, mild liver dysfunction, hypoproteinemia and hyponatremia were discovered. During hospitalization, troponin levels were positive. The patient was treated with oral high dose aspirin (100 mg/kg/d), two doses of intravenous immunoglobulin (IVIG 2 gm/kg) and three pulses of methylprednisolone. Two weeks later, cardiac evolvements were improved without further complications. The patient exhibited dramatically clinical recovery and was healthy after 8 weeks of follow-up.
This case indicates that Lymph-node-first presentation of Kawasaki disease could be examined in children with Kawasaki disease who exhibit symptoms of congestive cardiac failure, pericardial effusion and pericarditis during the acute phase of the disease.

Keywords

References

  1. Nomura Y, Arata M, Koriyama C, Masuda K, Morita Y, Hazeki D, et al. A severe form of Kawasaki disease presenting with only fever and cervical lymphadenopathy at admission. J Pediatr 2010; 156(5):786-91.
  2. Kanegaye JT, Van Cott E, Tremoulet AH, Salgado A, Shimizu C, Kruk P, et al. Lymph­node­first presentation of Kawasaki disease compared with bacterial cervical adenitis and typical Kawasaki disease. J Pediatr 2013; 162(6):1259-63.
  3. Yanagi S, Nomura Y, Masuda K, Koriyama C, Sameshima K, Eguchi T, et al. Early diagnosis of Kawasaki disease in patients with cervical lymphadenopathy. Pediatr Int 2008; 50(2):179-83.
  4. Kubota M, Usami I, Yamakawa M, Tomita Y, Haruta T. Kawasaki disease with lymphadenopathy and fever as sole initial manifestations. J Paediatr Child Health 2008; 44(6):359-62.
  5. Sonçaği A, Devrim I, Karagöz T, Dilber E, Celiker A, Ozen S, et al. Septated pericarditis associated with Kawasaki disease: a brief case report. Turk J Pediatr 2007; 49(3):312-4.
  6. Chantepie A, Mauran P, Lusson JR, Vaillant MC, Bozio A. Cardiovascular complications of Kawasaki syndrome: results of a French multicenter study. Arch Pediatr 2001; 8(7):713-9.
  7. Hunsaker DM, Hunsaker JC, Adams KC, Noonan JA, Ackermann DM. Fatal Kawasaki disease due to coronary aneurysm rupture with massive cardiac tamponade. J Ky Med Assoc 2003; 101(6):233-8.
  8. Reddy SV, Forbes TJ, Chintala K.Cardiovascular involvement in kawaski disease. Images Paediatr Cardiol 2005; 7(2):1-9.
  9. Adjagba PM, Desjardins L, Fournier A, Spegelblatt L, Montigny M, Dahdah N. N-terminal pro-brain natriuretic peptide in acute Kawasaki disease correlates with coronary artery involvement. Cardiol Young 2015; 25(7):1311-18.
  10. Checchia PA, Borensztajn J, Shulman ST. Circulating cardiac troponin I levels in kawasaki disease. Pediatr Cardiol 2001; 22(2):102-6.
  11. Fujiwara H, Hamashima Y. Pathology of the heart in kawasaki disease. Pediatrics 1978; 61(1):100-7.
  12. Rowley AH, Shulman ST. Kawasaki syndrome. Clin Microbiol Rev 1998; 11(3):405-14.
  13. D’Souza S, Khubchandani RP, Shetty AK. Kawasaki disease presenting with hemorrhagic pleural effusion. J Trop Pediatr 2006; 52(4):229-301.
  14. Okada S, Hasegawa S, Suzuki Y, Matsubara T, Shimomura M, Okuda M, et al. Acute pericardial effusion representing the TNF-α-mediated severe inflammation but not the coronary artery outcome of Kawasaki disease. Scand J Rheumatol 2014; 44(3):247-52.
  15. Dale RC, Saleem MA, Daw S, Dillon MJ. Treatment of severe complicated Kawasaki disease with oral prednisolone and aspirin. J Pediatr 2000; 137(5):723-6.
  16.  Yazdan Ghandi, Danial Habibi, Manigeh Kahbazi, Fatemeh Dorreh, Maryam Lotfi. Clinical Characteristics of Kawasaki Disease in Markazi Province, Iran. J Compr Ped 2020; 11(1):e85695. doi: 10.5812/compreped.85695

Journal of Kerman University of Medical Sciences
Volume 27, Issue 4
July and August 2020
Pages 362-368

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