TY - JOUR
T1 - Incomplete Kawasaki disease with coronary artery involvement
AU - Rowley, Anne H.
AU - Gonzalez-Crussi, Frank
AU - Gidding, Samuel S.
AU - Duffy, C. Elise
AU - Shulman, Stanford T.
N1 - Funding Information:
We report four children in whom significant coronary artery abnormalities developed after an illness that includ- Supported in part by The Kawasaki Research Fund of The Children's Memorial Hospital, Chicago, and by Grants IlL 34545 and AM 3069203 from the National Institutes of Health. Submitted for publication Sept. 5, 1986; accepted Oct. 29, 1986. Reprint requests: Anne H. Rowley, M.D., The Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614.
PY - 1987/3
Y1 - 1987/3
N2 - We report four patients with Kawasaki disease in whom characteristic coronary artery abnormalities developed after illnesses that did not meet diagnostic criteria. An additional patient lacked a history of acute manifestations of Kawasaki disease, but severe Kawasaki-like arterial changes were noted at autopsy. Fever was present in four of the five patients, in three lasting from 7 to 14 days. Despite manifestation of few classic acute clinical features of Kawasaki disease, three of four patients had desquamation of the fingers and toes 10 to 14 days after onset of illness, and the fifth had desquamation several months prior to death. These patients were seen over a 2-year period during which 22 other children were seen with Kawasaki disease with coronary artery abnormallties. Thus, strict adherence to currently accepted criteria for diagnosis of Kawasaki disease may lead to failure to recognize incomplete forms of this illness, with potential sequelae of myocardial infarction or sudden death. This finding suggest that children with prolonged unexplained febrile illnesses, especially those associated with subsequent peripheral desquamation, should undergo echocardiography 3 to 4 weeks after onset of the illness. This practice would help to identify those patients with illnesses characterized by incomplete diagnostic criteria but in whom significant coronary abnormalities develop.
AB - We report four patients with Kawasaki disease in whom characteristic coronary artery abnormalities developed after illnesses that did not meet diagnostic criteria. An additional patient lacked a history of acute manifestations of Kawasaki disease, but severe Kawasaki-like arterial changes were noted at autopsy. Fever was present in four of the five patients, in three lasting from 7 to 14 days. Despite manifestation of few classic acute clinical features of Kawasaki disease, three of four patients had desquamation of the fingers and toes 10 to 14 days after onset of illness, and the fifth had desquamation several months prior to death. These patients were seen over a 2-year period during which 22 other children were seen with Kawasaki disease with coronary artery abnormallties. Thus, strict adherence to currently accepted criteria for diagnosis of Kawasaki disease may lead to failure to recognize incomplete forms of this illness, with potential sequelae of myocardial infarction or sudden death. This finding suggest that children with prolonged unexplained febrile illnesses, especially those associated with subsequent peripheral desquamation, should undergo echocardiography 3 to 4 weeks after onset of the illness. This practice would help to identify those patients with illnesses characterized by incomplete diagnostic criteria but in whom significant coronary abnormalities develop.
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U2 - 10.1016/S0022-3476(87)80503-6
DO - 10.1016/S0022-3476(87)80503-6
M3 - Article
C2 - 3819942
AN - SCOPUS:0023137330
VL - 110
SP - 409
EP - 413
JO - Journal of Pediatrics
JF - Journal of Pediatrics
SN - 0022-3476
IS - 3
ER -