Affiliations: Hurley Medical Center, Pediatric Infectious Diseases
Department, Michigan State University, Flint, MI 48503, USA | Hurley Medical Center, Michigan State University,
Flint, MI 48503, USA
Note: [] Correspondence: Walid Abuhammour, MD, FAAP, Hurley Medical
Center, Pediatric Education 3W, One Hurley Plaza, Flint, MI 48503, USA. Tel.:
+1 810 762 7280; E-mail: wabuham1@hurleymc.com
Abstract: Due to lack of a specific diagnostic test, the diagnosis of Kawasaki
disease (KD) can only be made based on fever associated with characteristic
clinical features and exclusion of other diseases with similar presentation.
Incomplete presentation has been repeatedly described and often leads to delay
in diagnosis, which may result in coronary artery involvement. During an
eight-year study period (1991–1998), 14 patients with incomplete KD with
cardiac complications were identified. Age range was 3.5 months to 13 years; 11
patients were ⩽ 5 years of age. Fever lasting ⩾ 5 days was present
in all 14 patients, 10 of whom had a temperature ⩾ 40°C. Three
diagnostic clinical criteria of KD were present in seven patients, two criteria
in five patients, and one criterion in two patients. Echocardiography showed
ectasia/aneurysm of at least one coronary artery in all patients. Coronary
artery involvement was detected and treated after 5–7 days of illness in
50% of the patients, after 7–10 days in 29%, and after 10 days in 21%
of the patients. All patients had elevated erythrocyte sedimentation rate (ESR)
(mean ESR =48 mm/h). Twelve patients had leukocyte count ⩾
16,000/mm^{3}. All patients were treated with Intravenous Immunoglobulin
(IVIG) and oral aspirin. Clinical and echocardiographic
resolution occurred in 13 patients. One patient, whose diagnosis was made 25
days after the onset of fever, died of pulmonary hemorrhage secondary to a
pulmonary artery aneurysm. Although this retrospective study is limited by the
small number of patients, it showed that children with incomplete KD-especially
⩽ 5 years of age-with high fever (⩾40°C), leukocytosis
(⩾ 16.000/mm^{3}) and elevated ESR (⩾ 40 mm/h), developed cardiac
complications as early as the fifth day of illness. We suggest that earlier
diagnosis and prompt treatment with intravenous gamma globulin before the fifth
day of fever might reduce cardiac complications.
