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Medicine (Baltimore). 2019 Oct;98(42):e17595. doi: 10.1097/MD.0000000000017595.

The peculiarities of Kawasaki disease at the extremes of age: Two case reports.

Author information

1
Department of Paediatrics.
2
Department of Paediatric, University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, Gheorghe Marinescu Street No. 38, Târgu Mures 540136, Romania.

Abstract

RATIONALE:

Extremes of age is an important risk factor for the development of coronary arteries aneurysms (CAAs) associated to Kawasaki disease (KD) along with male gender, prolonged fever and a delay in diagnosis or treatment.

PATIENT CONCERNS:

We report two cases of KD in the extremes of age, a 5-month-old male infant and a 9-year-old child in order to underline the features of this disorder outside the typical age range of 1 to 4 years. The 5-month-old male was admitted in our clinic for generalized polymorphous exanthema and fever for approximately 7 days. The laboratory test pointed out leukocytosis and increased inflammatory biomarkers. The 9-year-old male child was admitted in our clinic for fever and submandibular adenopathy. The onset was approximately 5 days before the admission with a sudden development of unilateral, painless, submandibular lymphadenopathy for which the ENT specialist recommended antibiotics and nonsteroid anti-inflammatory drugs. In the 2nd day of admission, he presented severe desquamation of hands and soles.

DIAGNOSIS:

Both cases were diagnosed with KD. The echocardiography showed no cardiac impairment in the infant, while in the older patient it revealed mild dilation of the left coronary artery.

INTERVENTIONS:

Both patients received intravenously immunoglobulin and pulsed methylprednisolone.

OUTCOMES:

The evolution was favorable in both cases, but in the infant, the C-reactive protein levels persisted mildly elevated for approximately 2 months after the diagnosis.

LESSONS:

The peculiarities of KD in the extremes of age are related to a higher frequency of incomplete features and an increased incidence of coronary artery lesions resulting in a delay of the diagnosis, and subsequent poorer outcomes.

PMID:
31626134
DOI:
10.1097/MD.0000000000017595
[Indexed for MEDLINE]
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