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Kawasaki facile e difficile
Easy and difficult diagnoses of Kawasaki disease: ten teachings through resident's case reports
Elisa Benelli1, Simone Carbogno2, Nicolina Stefania Carucci3, Martina Gori4, Edoardo Marrani5, Marta Melis6, Maria Chiara Pellegrin1
1Università di Trieste; 2Università “La Sapienza”, Roma; 3Policlinico Universitario “G. Martino”, Università di Messina; 4Clinica Pediatrica, Dipartimento di Medicina Clinica e Sperimentale dell’Università di Pisa, Azienda Ospedaliera-Universitaria Pisana; 5Servizio di Reumatologia Pediatrica, Ospedale “Anna Meyer”, Firenze; 6Scuola di Specializzazione in Pediatria, Università di Cagliari
Marzo 2017 - pagg. 155 -162
Abstract
Kawasaki disease (KD) is a systemic vasculitis that typically affects children of 2-5 years of
age and whose diagnosis and treatment are usually easy, as described in the first case
report. Anyway, in spite of adequate therapy, 10-15% of patients develop coronary artery
aneurysms. The high-risk patients are those under 1 year of age or with incomplete or atypical
presentations. For this reason, to recognize them promptly is fundamental to start adequate
therapy. This article describes some cases of the atypical presentation of KD: a retropharyngeal
abscess, a febrile cholestatic jaundice and a haemophagocytic syndrome. Moreover,
it reports some severe cases of KD such as a severe cardiac shock, the case of a patient that
received anti-TNF therapy because of inefficacy of standard therapy and finally the case of
an adult that underwent coronary artery bypass surgery because of the consequences of a
giant coronary aneurism developed at 2 years of age after a KD. At the end of the article,
the messages inferred from the described case reports are summarized in 10 points.
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Bibliografia
1 Giani T, Simonini G, Vannucci G, et al. La
malattia di Kawasaki nel 2013: casi clinici e
novità. Medico e Bambino 2013;32(6):359-66.
2. Pellegrin MC, Taddio A, Ventura A, Lepore
L. La malattia di Kawasaki: ancora una sfida
per il pediatra. Medico e Bambino 2011;30(4):
236-41.
3. Eleftheriou D, Levin M, Shingadia D, Tulloh
R, Klein NJ, Brogan PA. Management of
Kawasaki disease. Arch Dis Child 2014;99(1):
74-83.
4. Newburger JW, Takahashi M, Gerber MA,
et al. Diagnosis, treatment, and long-term management
of Kawasaki disease: a statement
for health professionals from the Committee
on Rheumatic Fever, Endocarditis and Kawasaki
Disease, Council on Cardiovascular Disease
in the Young, American Heart Association.
Circulation 2004;110(17):2747-71.
5. Muta H, Ishii M, Egami K, et al. Early intravenous
gamma-globulin treatment for Kawasaki
disease: the nationwide surveys in Japan.
J Pediatr 2004;144(4):496-9.
6. Son MB, Gauvreau K, Burns JC, et al. Infliximab
for intravenous immunoglobulin resistance
in Kawasaki disease: a retrospective
study. J Pediatr 2011;158(4):644-9.
7. Tremoulet AH, Jain S, Jaggi P, et al. Infliximab
for intensification of primary therapy for
Kawasaki disease: a phase 3 randomised, double-
blind, placebo-controlled trial. Lancet
2014;383(9930):1731-8.
8. Kritsaneepaiboon S, Tanaanantarak P, Roymanee
S, Lee EY. Atypical presentation of
Kawasaki disease in young infants mimicking
a retropharyngeal abscess. Emerg Radiol
2012;19(2):159-63.
9. Nomura O, Hashimoto N, Ishiguro A, et al.
Comparison of patients with Kawasaki disease
with retropharyngeal edema and patients with
retropharyngeal abscess. Eur J Pediatr 2014;
173(3):381-6.
10. Taddio A, Pellegrin MC, Centenari C, Filippeschi
IP, Ventura A, Maggiore G. Acute febrile
cholestatic jaundice in children: keep in
mind Kawasaki disease. J Pediatr Gastroenterol
Nutr 2012;55(4):380-3.
11. Wang W, Gong F, Zhu W, Fu S, Zhang Q.
Macrophage activation syndrome in Kawasaki
disease: more common than we thought? Semin
Arthritis Rheum 2015;44(4):405-10.
12. Ravelli A, Minoia F, Davì S, et al. 2016 classification
criteria for macrophage activation
syndrome complicating systemic juvenile idiopathic
arthritis: a European League against
Rheumatism / American College of Rheumatology
/ Paediatric Rheumatology International
Trials Organisation Collaborative Initiative.
Ann Rheum Dis 2016;75(3):481-9.
13. Kanegaye JT, Wilder MS, Molkara D, et
al. Recognition of a Kawasaki disease shock
syndrome. Pediatrics 2009;123(5):e783-9.
14. Taddio A, Rossi ED, Monasta L, et al. Describing
Kawasaki shock syndrome: results
from a retrospective study and literature review.
Clin Rheumatol 2017;36(1):223-8.
15. Friedman KG, Gauvreau K, Hamaoka-Okamoto
A, et al. Coronary artery aneurysms in
Kawasaki disease: risk factors for progressive
disease and adverse cardiac events in the US
population. J Am Heart Assoc 2016;5(9).
16. Dionne A, Bakloul M, Manlhiot C, et al.
Coronary artery bypass grafting and percutaneous
coronary intervention after Kawasaki
disease: the Pediatric Canadian Series. Pediatr
Cardiol 2017;38(1):36-43.
17. Pinches H, Dobbins K, Cantrell S, May J,
Lopreiato J. Asymptomatic Kawasaki disease in
a 3-month-old infant. Pediatrics 2016;138(2).
18. Rowley AH. The complexities of the diagnosis
and management of Kawasaki disease.
Infect Dis Clin North Am 2015;29(3):525-37.
19. Saguil A, Fargo M, Grogan S. Diagnosis
and management of Kawasaki disease. Am
Fam Physician 2015;91(6):365-71.
20. Newburger JW, Takahashi M, Burns JC.
Kawasaki disease. J Am Coll Cardiol 2016;67
(14):1738-49.
21. Zhu FH, Ang JY. The clinical diagnosis
and management of Kawasaki disease: a review
and update. Curr Infect Dis Rep 2016;18
(10):32.
22. Tajima M, Shiozawa Y, Kagawa J. Early appearance
of principal symptoms of Kawasaki
disease is a risk factor for intravenous immunoglobulin
resistance. Pediatr Cardiol 2015;36
(6):1159-65.
23. Murgia V. Sindrome di Kawasaki: l’uso dei
corticosteroidi alla luce delle evidenze. Medico
e Bambino pagine elettroniche 2014;17(3).
24. Marchetti F. La fine della questione sull’uso
del cortisone nella malattia di Kawasaki?
Medico e Bambino pagine elettroniche 2014;
17(3).
25. Chen S, Dong Y, Kiuchi MG, et al. Coronary
artery complication in Kawasaki disease
and the importance of early intervention: a systematic
review and meta-analysis. JAMA Pediatr
2016;170(12):1156-63.
26. Eleftheriou D, Levin M, Shingadia D, Tulloh
R, Klein NJ, Brogan PA. Management of
Kawasaki disease. Arch Dis Child 2014;99(1):
74-83.
27. Saulsbury FT. Comparison of high-dose
and low-dose aspirin plus intravenous immunoglobulin
in the treatment of Kawasaki syndrome.
Clin Pediatr (Phila) 2002;41(8):597-601.
28. Lee G, Lee SE, Hong YM, Sohn S. Is highdose
aspirin necessary in the acute phase of
Kawasaki disease? Korean Circ J 2013;43(3):
182-6.
29. Marchetti F, Mambelli L, Pusceddu S. Ha
ancora un ruolo l’uso dell’aspirina nella malattia
di Kawasaki e, se sì, a quale dosaggio? Medico
e Bambino 2014;33:667-8.
Corrispondenza: elisa.benelli@gmail.com