A severe form of Kawasaki disease presenting with only fever and cervical lymphadenopathy at admission.
OBJECTIVE
To examine the characteristics of patients with Kawasaki disease (KD) presenting with only fever and cervical lymphadenopathy at admission.


METHODS
The laboratory and clinical findings of patients with definite KD presenting with only fever and cervical lymphadenopathy at admission (KDiL) were compared with those of all other patients with KD.


RESULTS
Sixteen patients with KDiL (8.6%) and 171 patients without KDiL were examined. The patients with KDiL were significantly older (KDiL/non-KDiL: 4.9+/-2.5/2.2+/-1.9 years) and admitted earlier (3.0+/-1.2/3.9+/-1.3 days of illness) than the patients without KDiL. They also showed significantly elevated white blood cell counts and C-reactive protein levels. Patients with KDiL were treated with the same dose of intravenous immunoglobulin as the patients without KDiL but were treated slightly later and had significantly higher frequency of additional intravenous immunoglobulin treatment (38%/10%) and coronary artery abnormalities (25%/5%). After adjustment for age, white blood cell count, and day of illness at admission or first intravenous immunoglobulin administration, the presence of KDiL significantly increased the risk of being a nonresponder to IVIG treatment or development of a coronary artery abnormality.


CONCLUSIONS
KDiL indicates a severe form of KD associated with increased risks of additional intravenous immunoglobulin treatment and coronary artery abnormalities. Patients with KDiL may require heightened surveillance and more aggressive treatment.
Nomura
Yuichi
Y
Division of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan. uichi@m2.kufm.kagoshima-u.ac.jp
Arata
Michiko
M
Koriyama
Chihaya
C
Masuda
Kiminori
K
Morita
Yasuko
Y
Hazeki
Daisuke
D
Ueno
Kentaro
K
Eguchi
Taisuke
T
Kawano
Yoshifumi
Y
D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000150:complications*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors; D007223:Infant; D008199:Lymphadenitis / Q000175:diagnosis; D008206:Lymphatic Diseases / Q000150:complications*; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D009333:Neck
D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors