title: A severe form of Kawasaki disease presenting with only fever and cervical lymphadenopathy at admission.
abstract: 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.
authors.affiliation: Division of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan. uichi@m2.kufm.kagoshima-u.ac.jp
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Nomura
authors.forename: Michiko
authors.initials: M
authors.lastname: Arata
authors.forename: Chihaya
authors.initials: C
authors.lastname: Koriyama
authors.forename: Kiminori
authors.initials: K
authors.lastname: Masuda
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Morita
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hazeki
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ueno
authors.forename: Taisuke
authors.initials: T
authors.lastname: Eguchi
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kawano
mesh_terms: 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
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors