Overlaping Syndromes: Kawasaki-Like Disease in Pediatric Multisystem Inflammatory Syndrome vs Atypical Kawasaki Disease. British or American? One Case, Many Possibilities
Article Category: Case Presentation
Published Online: May 05, 2022
Page range: 897 - 902
DOI: https://doi.org/10.47803/rjc.2020.31.4.897
Keywords
© 2021 Cristiana Voicu et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Figure 1
Figure 2
Figure 3
Comparative view of the diagnostic criteria in Kawasaki disease, incomplete or atypical Kawasaki disease, and pediatric multisystemic inflammatory syndrome1,11
| Fever, and 4/5 criteria:
Erythema and cracked lips, strawberry tongue and/or erythema of the pharynx and oral mucosa Bilateral bulbar conjunctival injection Rash maculopapular, erythematous Erythema and edema of the hands and feet in acute phase or periungual desquamation in subacute phase Cervical lymph nodes ≥1.5 cm. |
Children with
• Prolonged Fever (≥5 days) • 2–3 criteria OR Infants with Prolonged Fever (≥7 days without other explanation) Compatible laboratory tests (3 of the 6 criteria)
anemia thrombocytosis after the 7th day of fever albumin level ≤3 g/dl elevated ALT level WBC≥15,000/mm3 Urine≥10WBC/hpf Compatible echocardiographic findings (any of the following)
Z score LAD or RCA ≥2.5 Coronary artery aneurysm ≥3 features from:
Decreased LV function Pericardial effusion Z score LAD 2–2.5 Mitral regurgitation |
Child 0–19 years Fever ≥3 days Clinical signs of multisystem involvement (at least 2 of following):
rash/bilateral non-purulent conjunctivitis/mucocutaneous inflammation signs: oral, hands or feet hypotension or shock features of myocardial dysfunction, pericarditis, valvulitis, coronary abnormalities (echo findings or troponin/NT proBNP) evidence of coagulopathy (prolonged prothrombin time, partial thromboplastin time or elevated D-dimers) Acute gastrointestinal symptoms (diarrhea, vomiting, abdominal pain) Elevated markers of inflammation such as C reactive protein, procalcitonin, erythrocyte sedimentation rate. No other obvious microbial cause of inflammation, including bacterial sepsis, staphylococcal/streptococcal toxic shock syndrome Evidence of COVID-19 (RT PCR, antigen test, serology) or likely contact with patients with COVID-19 |