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Kim N, Choi YJ, Na JY, Oh JW. Lymph-node-first presentation of Kawasaki disease in a 12-year-old girl with cervical lymphadenitis caused by Mycoplasma pneumoniae: A case report. World J Clin Cases 2022; 10:3170-3177. [PMID: 35611136 PMCID: PMC9082695 DOI: 10.12998/wjcc.v10.i10.3170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/12/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To the best of our knowledge, cases of Kawasaki disease (KD) occurring at the age of 12 are rare, even in Asia where the incidence of KD is high. We report a case of lymph-node-first presentation of KD (NFKD) in a 12-year-old girl with Mycoplasma pneumoniae (M. pneumoniae) infection who presented with prolonged fever and lymphadenitis refractory to macrolide antibiotics.
CASE SUMMARY A previously healthy 12-year-old girl presented with fever, myalgia, sore throat, swelling, and tenderness on the right side of the neck. She was initially diagnosed with lymphadenitis caused by M. pneumoniae refractory to macrolide antibiotics. She had elevated brain natriuretic peptide (BNP) levels. Finally, the patient was diagnosed with KD. After receiving intravenous immunoglobulin, the fever resolved, and her symptoms improved.
CONCLUSION NFKD should be differentiated from adolescent lymphadenitis presenting with prolonged fever by checking the BNP level early.
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Affiliation(s)
- Nayoung Kim
- Department of Pediatrics, Hanyang University Seoul Hospital, Seoul 04763, South Korea
| | - Young-Jin Choi
- Department of Pediatrics, Hanyang University Guri Hospital, Guri-si 11923, South Korea
| | - Jae Yoon Na
- Department of Pediatrics, Hanyang University Seoul Hospital, Seoul 04763, South Korea
| | - Jae-Won Oh
- Department of Pediatrics, Hanyang University School of Medicine, Seoul 04763, South Korea
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Takikawa H, Ae R, Matsubara Y, Matsubara D, Makino N, Kosami K, Kuwabara M, Sasahara T, Nakamura Y. Bacille Calmette-Guérin inoculation site changes and cardiac complications in patients with Kawasaki disease. Arch Dis Child 2021; 106:669-673. [PMID: 33303488 DOI: 10.1136/archdischild-2020-319543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate whether redness and crusting at the bacille Calmette-Guérin inoculation site (BCGitis), identified during acute illness owing to Kawasaki disease (KD), is an independent risk factor for development of cardiac complications. DESIGN Retrospective cohort study using data from the nationwide KD survey in Japan. SETTING Survey respondents included hospitals specialising in paediatrics and hospitals with ≥100 beds and a paediatric department throughout Japan. PATIENTS We included 17 181 patients with KD across Japan during 2005-2006. MAIN OUTCOME MEASURES BCGitis and cardiac complications resulting from KD. RESULTS BCGitis was identified in 7549 (44%) patients with KD. Compared with patients without BCGitis, those with BCGitis were younger, more likely to be male, less likely to have recurrent status and visited a hospital and underwent initial intravenous immunoglobulin (IVIG) treatment earlier after KD onset. In the unadjusted model, patients with BCGitis were significantly less likely to have cardiac complications (crude OR 0.81, 95% CI 0.71 to 0.92). However, after including treatment factors (days of illness at initial IVIG and treatment responsiveness) in the adjusted model, the association was no longer significant (adjusted OR 0.89, 95% CI 0.77 to 1.03), indicating that BCGitis was not an independent factor associated with cardiac complication and might be confounded by treatment factors. CONCLUSIONS BCGitis was identified in comparatively early illness stages of KD. Our findings indicated that BCGitis was not an independent factor associated with developing cardiac complications but was confounded by prompt initial IVIG administration, which might result in successful treatment and prevention of cardiac complications.
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Affiliation(s)
- Haruki Takikawa
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yuri Matsubara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Daisuke Matsubara
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Nobuko Makino
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Masanari Kuwabara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Teppei Sasahara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yosikazu Nakamura
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Abstract
BACKGROUND Kawasaki disease (KD) is an acute self-limited systemic vasculitis that primarily affects children <5 years old. There is no specific diagnostic test. A reaction at the Bacille Calmette-Guérin (BCG) inoculation site has been reported as a common finding in patients with KD where BCG vaccination is mandatory. The purpose of this study was to evaluate the frequency of reactivation of the BCG in Mexican children diagnosed with KD. METHODS A retrospective study of all patients diagnosed with KD from August 1, 1995, to August 31, 2015, at our Institution was performed. The clinical profile, laboratory results, treatment used and coronary artery abnormalities in the BCG reactive and the BCG nonreactive groups were analyzed and compared. RESULTS We included 399 patients with KD. Ninety-seven (24.3%) had BCG reaction at the inoculation site. The BCG(+) group was younger than the BCG(-) group (P < 0.000). There were 18 (18.55%) incomplete cases in the BCG(+) group compared with 65 (21.52%) in the BCG(-) group without statistical significance. The BCG+ group developed coronary artery aneurysms in 37 cases and the BCG(-) group developed coronary artery aneurysms in 111 cases without statistical significance. Multivariate analysis showed that younger age at diagnosis was the only variable associated with a reaction at the BCG inoculation site in patients with KD. CONCLUSIONS In Mexico, a country with a National BCG Vaccination Program and a low incidence of KD, reaction at the BCG inoculation site could be a useful diagnostic sign of KD.
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Facial nerve palsy including Bell's palsy: Case definitions and guidelines for collection, analysis, and presentation of immunisation safety data. Vaccine 2016; 35:1972-1983. [PMID: 27235092 DOI: 10.1016/j.vaccine.2016.05.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/09/2016] [Indexed: 12/17/2022]
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Suliman OS, Abdelnasser M. Incomplete Kawasaki disease: The usefulness of BCG reactivation as a diagnostic tool. Sudan J Paediatr 2012; 12:84-8. [PMID: 27493333 PMCID: PMC4949825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Kawasaki disease (KD) is an extremely rare condition in infants younger than 3 months old. Cardiovascular complications are unfortunately most common in young infants and it is in this age group, incomplete Kawasaki disease (IKD) is more frequently reported. Because IKD is a diagnostic dilemma, any sign that could help early diagnosis, such as BCG reactivation is useful. Here we report on an infant less than 3 months old with IKD wherein, BCG reactivation helped us in making the diagnosis. In this article, we highlight the usefulness of this sign for early diagnosis of IKD, especially in countries where BCG vaccination is still part of the immunization schedule.
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Heuclin T, Dubos F, Hue V, Godart F, Francart C, Vincent P, Martinot A. Increased detection rate of Kawasaki disease using new diagnostic algorithm, including early use of echocardiography. J Pediatr 2009; 155:695-9.e1. [PMID: 19595368 DOI: 10.1016/j.jpeds.2009.04.058] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 02/19/2009] [Accepted: 04/24/2009] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the incidence of Kawasaki disease (KD) in Northern France by using new American Heart Association (AHA) criteria. STUDY DESIGN A 1-year prospective multicenter cohort study was performed in all pediatric departments. Patients <18 years old, who were admitted for prolonged but initially unexplained fever or suspected KD were included. All patients received the standard treatment considered appropriate by their physicians. A descriptive analysis and comparison of patients with complete and incomplete forms of KD were performed. The incidence of confirmed cases of KD (complete and incomplete forms) was calculated. RESULTS Seventy-seven children were included (39 in whom KD was diagnosed). Of the patients with KD, 26 (67%) met the classic AHA case definition, and 7 (18%) had incomplete KD. Cardiac ultrasound scanning was helpful in the diagnosis of 6 of 7 patients with incomplete KD (86%). The final incidence of confirmed KD was 9 of 100,000 children <5 years of age. In 6 children (15%) the diagnosis of KD was uncertain, but they were successfully treated for it. Coronary disease was identified in 48% of patients with confirmed KD. CONCLUSION The incidence of KD is higher than previously reported, in part because earlier reports did not include incomplete forms. New AHA criteria (laboratory tests and early echocardiography) were helpful for the diagnosis of incomplete forms of KD.
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Affiliation(s)
- Thérèse Heuclin
- Lille University Hospital, Faculté de Médecine Henri Warembourg, Lille-2 University, Lille, France
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Mukhtyar C, Brogan P, Luqmani R. Cardiovascular involvement in primary systemic vasculitis. Best Pract Res Clin Rheumatol 2009; 23:419-28. [DOI: 10.1016/j.berh.2009.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brogan RJ, Eleftheriou D, Gnanapragasam J, Klein NJ, Brogan PA. Infliximab for the treatment of intravenous immunoglobulin resistant Kawasaki disease complicated by coronary artery aneurysms: a case report. Pediatr Rheumatol Online J 2009; 7:3. [PMID: 19159441 PMCID: PMC2646726 DOI: 10.1186/1546-0096-7-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 01/21/2009] [Indexed: 01/29/2023] Open
Abstract
This case report describes an 8 year old boy with IVIG resistant Kawasaki disease complicated by severe bilateral coronary artery aneurysms successfully treated with infliximab, a monoclonal antibody against tumour necrosis factor alpha.
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Affiliation(s)
- Robert J Brogan
- Department of Paediatric Rheumatology, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London, UK.
| | - Despina Eleftheriou
- Department of Paediatric Rheumatology, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London, UK
| | - James Gnanapragasam
- Congenital Cardiac Centre, North Wing, Southampton University Hospitals NHS Trust, Tremona Road, Southampton, UK
| | - Nigel J Klein
- Department of Infectious disease and Microbiology, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London, UK
| | - Paul A Brogan
- Department of Paediatric Rheumatology, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London, UK
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Rath B, Linder T, Cornblath D, Hudson M, Fernandopulle R, Hartmann K, Heininger U, Izurieta H, Killion L, Kokotis P, Oleske J, Vajdy M, Wong V. “All that palsies is not Bell's [1]”—The need to define Bell's palsy as an adverse event following immunization. Vaccine 2007; 26:1-14. [DOI: 10.1016/j.vaccine.2007.10.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 10/16/2007] [Accepted: 10/18/2007] [Indexed: 12/01/2022]
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Grüber C, Wendt M, Sulser C, Lau S, Kulig M, Wahn U, Werfel T, Niggemann B. Randomized, placebo-controlled trial of Lactobacillus rhamnosus GG as treatment of atopic dermatitis in infancy. Allergy 2007; 62:1270-6. [PMID: 17919141 DOI: 10.1111/j.1398-9995.2007.01543.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Some studies have suggested that supplementation of food with lactobacilli may prevent or improve atopic dermatitis in children. This study was designed to investigate the therapeutic effect of Lactobacillus rhamnosus GG (LGG) as a food supplement in infants suffering from atopic dermatitis. METHODS Infants aged 3-12 months suffering from mild-to-moderate atopic dermatitis (severity scoring of atopic dermatitis or SCORAD index of 15-40) without current antiinflammatory treatment were randomized to receive LGG (5 x 10(9) colony forming units b.i.d.) or placebo as a food supplement for 12 weeks. Severity scoring of atopic dermatitis index and use of hydrocortisone 1% ointment as rescue medication (2 points per application) were recorded at 4, 8, and 12 weeks of treatment and combined as symptom load (SL). RESULTS Fifty-four infants (LGG group, mean +/- SD SCORAD index 24.6 +/- 8.8) and 48 infants (placebo group, SCORAD index 23.6 +/- 7.8) were randomized and completed the treatment period (intention-to-treat analysis). Symptom load generally improved over time at 4 weeks (LGG vs placebo, 23.8 +/- 12.4 vs 20.6 +/- 9.9), 8 weeks (22.5 +/- 14.6 vs 17.9 +/- 13.1), and 12 weeks (19.6 +/- 15.4 vs 15.1 +/- 12.1), without statistically significant group differences. When stratified for age, eczema severity or use of rescue medication, no statistically significant group differences, in improvement, were found. No significant group differences were found for the use of rescue medication (0.8 +/- 45.0 g vs 3.5 +/- 29.8 g), increase in mean logarithmic total serum IgE (0.17 +/- 0.30 kU/l vs 0.26 +/- 0.45 kU/l), and newly developed allergic sensitization against hen's egg or cow's milk (18.8%vs 10.0%). CONCLUSION This placebo-controlled trial showed no therapeutic effect of LGG against mild-to-moderate atopic dermatitis in infancy.
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Affiliation(s)
- C Grüber
- Department of Pediatric Pneumology and Immunology, Universitätsmedizin Berlin, Charité, Berlin, Germany
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Bibliography. Current world literature. Vasculitis syndromes. Curr Opin Rheumatol 2006; 19:81-5. [PMID: 17143101 DOI: 10.1097/bor.0b013e32801437a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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