[Meningoencephalitis in Kawasaki disease].
Kawasaki disease (KD) is a syndrome characterized by various degrees of vasculitis in small-and medium-sized arteries. We discussed the characteristic manifestations and prognosis of 5 KD patients (male 3, female 2) with meningoencephalitis in the acute stage. The incidence was 3.7% (5 of 138 patients) in our institute. The age of onset was between 3 months and 15 months. The clinical manifestations included disturbance of consciousness and seizures; disturbance of consciousness developed in all patients in the early acute stage. The duration was between 2 and 11 days; seizures developed as status convulsions in two. Electroencephalograms (EEG) demonstrated certain abnormalities in 2 of 4 patients studied. Computed-tomographic scanning (CT scan) revealed fluid collection in the frontal extracerebral space, and monocyte-predominant pleocytosis was observed in the cerebrospinal fluid (CSF) in all 5 patients studied. The age of onset in the 5 KD patients was significantly earlier than that in non-complicated cases (n = 138, P less than 0.01). Blood hemoglobin (P less than 0.05) and hematocrit (P less than 0.05), serum total protein (P less than 0.01), and serum albumin levels (P less than 0.01) were also significantly lower. Moreover the period until CRP values turned negative was significantly longer (P less than 0.05) and erythrocyte sedimentation rate was significantly lower (P less than 0.01) in these 5 patients. It was considered that meningoencephalitis in KD may develop in cases having more severe and prolonged inflammatory changes; the clinical findings revealed a serious form of KD. We suggest that this might because by vasculitis of small arteries, arterioles, capillaries, and venules, which consists of infiltration of lymphocytes and large mononuclear cells, and edema. There was no neurological sequela in 4 of the 5 patients. However, one patient was found to have hearing difficulty 3 years after the onset. Therefore, the prognosis of meningoencephalitis in KD was considered to be generally favorable.
Takagi
K
K
First Department of Pediatrics, Toho University School of Medicine, Tokyo.
Umezawa
T
T
Saji
T
T
Morooka
K
K
Matsuo
N
N
D001921:Brain / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008590:Meningoencephalitis / Q000209:etiology* / Q000473:pathology; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications*; D011379:Prognosis; D012640:Seizures / Q000209:etiology; D014057:Tomography, X-Ray Computed