Case of Atypical Kawasaki Disease

Dr.B.Shobika,Dr.C.Jayakumar,Dr.Praveena Bhaskar and Dr.Navya George

AIMS KOCHI

Two year old male child presented to the ER with high Grade intermittent fever of 10 days.

child was febrile,sicklooking,irritable with stable vitals.General examination revealed bilateral cervical lymphadenopathy,congested throat,slightly erythematous lips but Tongue was normal 

His systemic examination was normal 

Hemogram showed leucopenia and Neutropenia,CRP-194mg/l,procalcitonin-3.43ng/ml,ESR of 135mm.Peripheral smear normal .LFT/RFT/PT/INR ,APTT ,electrolytes urine routine  were within normal limits.

Other investigations like Dengue,IgM EBV,parvovirus,IgM and IgG salmonella were Negative.

Cultures of Blood and Urine were normal  

Respiratory viral pannel didn’t isolate any virus 

Abdominal sonogram was normal 

CSF Study was normal

As  no focus of infections  were found and  high grade fever was  persisting.

CECT was neck done to r/o retropharyngeal/parapharyngeal abscess were done and showed adenoid hypertrophy and Inhaled nasal Steroids was given

Cardiac evaluation ECHO  showed mild pericardial effusion and no dilatation  of the coronaries

CSF ,AFB smear Negative,CSF gene Xpert showed trace of MTB(insignificant in the context of viral CSF study with respect to normal  cell cytology and protein)

Bone marrow aspiration done showed pauciparticulate marrow with diluted cell trails showing predominantly erythroids and lymphocytes.

He was started on Inj.cefepime,vancomycin and other supportive medication after taking blood and urine for culture and sensitivity.Fever was  persisting inspite of  the antibiotics.

In this contex atypical Kawasaki disease was considered and 2gm/kg IVIg was started

Criteria fulfilling as atypical kawasaki disease – fever of more than 5 days,cervical lymphadenopathy,erythematous oral mucosa.

Fever spikes reduced after giving IVIG.Labs shows decreasing trend (CRP-15.24,TLC-6.72,N-16.9,ESR 20mm )

Repeat ECHO done  was normal.

Carry home message:

Atypical Kawasaki disease should be considered  In children below 5 years of age, with persisting fever spikes after ruling out other possibilities and treatment with IviG  is justified

We have not given Aspirin in this case as coronaries were normal and as both CRP and ESR were normal

One Reply to “Case of Atypical Kawasaki Disease”

  1. I am Dr sahil. Lifeline hospital adoor.
    I referred this case as febrile neutropenia.i was thinking in terms of macrophage activation syndrome .

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