Yamashita K, Kanazawa T, Abe Y, Naruto T, Mori M. Kawasaki disease without changes in inflammatory biomarkers: A case report. World J Clin Cases 2022; 10(35): 13038-13043 [PMID: 36569014 DOI: 10.12998/wjcc.v10.i35.13038]
Corresponding Author of This Article
Kosei Yamashita, MD, Doctor, Children’s Medical Center, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu Koto-Ku, Tokyo 135-8577, Japan. meko11115@med.showa-u.ac.jp
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 16, 2022; 10(35): 13038-13043 Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.13038
Kawasaki disease without changes in inflammatory biomarkers: A case report
Kosei Yamashita, Takeru Kanazawa, Yoshifusa Abe, Takuya Naruto, Masaaki Mori
Kosei Yamashita, Takeru Kanazawa, Yoshifusa Abe, Children’s Medical Center, Showa University Koto Toyosu Hospital, Tokyo 135-8577, Japan
Takuya Naruto, Masaaki Mori, Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
Masaaki Mori, Department of Rheumatology, Clinical Immunology and Allergology, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
Author contributions: Yamashita K was the first author of this manuscript; Kanazawa T advised and helped revise the manuscript; Abe Y analyzed the data and drafted the manuscript; Naruto T was measured as leucine-rich alpha-2-glycoprotein; Mori M measured leucine-rich alpha-2-glycoprotein and provided critical comments on the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient’s parents for publication of this case report and any accompanying images.
Conflict-of-interest statement: There is no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kosei Yamashita, MD, Doctor, Children’s Medical Center, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu Koto-Ku, Tokyo 135-8577, Japan. meko11115@med.showa-u.ac.jp
Received: August 16, 2022 Peer-review started: August 16, 2022 First decision: October 21, 2022 Revised: November 4, 2022 Accepted: November 18, 2022 Article in press: November 18, 2022 Published online: December 16, 2022
Abstract
BACKGROUND
Kawasaki disease (KD) is diagnosed based on clinical features. Blood tests and other tests are auxiliary diagnostic tools. Since KD is a disease caused by arterial inflammation, many patients with KD have elevated levels of inflammatory biomarkers, such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and serum amyloid A protein (SAA) in blood tests. We report our experience of a patient with KD who did not have elevated levels of inflammatory biomarkers.
CASE SUMMARY
A 1-year-old boy presented with a 3-day history of fever. Five of the six symptoms of KD were observed, except for changes in the lips and oral cavity. Blood tests revealed no elevation in CRP, ESR, or SAA levels. Although the blood test results were atypical, the patient was diagnosed with KD based on clinical symptoms and was admitted to the hospital for treatment. The patient was administered intravenous immunoglobulin (IVIG) and aspirin. Despite commencing treatment, the fever persisted; therefore, additional IVIG was administered, the dosage of aspirin was increased, and ulinastatin was added. Three doses of IVIG were administered and the fever resolved on day 11 of KD symptoms started. Blood tests performed during hospitalization showed normal levels of inflammatory biomarkers. We examined leucine-rich alpha-2-glycoprotein 1 - a protein that is elevated during the acute phase of KD. The protein levels did not increase during hospitalization.
CONCLUSION
This case suggests the need to identify criteria and biomarkers for detecting KD conditions that do not require KD treatment.
Core Tip: Cases of Kawasaki disease in children with not elevated levels of inflammatory biomarkers, such as C-reactive protein, erythrocyte sedimentation rate, and serum amyloid A protein, are reported. This study clarified the need to identify criteria and biomarkers to detect Kawasaki disease conditions that do not require treatment.
