Severe Skin Lesions or Arthritis May be Associated with Coronary Artery Lesions in Kawasaki Disease
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Purpose: Kawasaki disease (KD) shows a variety of clinical signs of multi-system involvement, including clinical diagnostic criteria. It is unknown that the severity of the clinical signs is associated with the risk of coronary artery lesions (CALs). We wanted to evaluate clinical characteristics and the risk of CALs in the patient groups who had severe skin lesions or those with arthritis. Methods: We retrospectively reviewed the medical records of 220 KD patients who were treated with intravenous immunoglobulin (IVIG). We compared clinical and laboratory data between the group with severe skin lesions (n=52) and those with mild or no skin lesions (n=168), and between the group with arthritis (n=6) and those without arthritis (n=214). Results: The mean age of total patients was 2.23±1.87 years of age, and the male-to-female ratio was 1.5:1 (138/82). Among 220 patients, 52 patients had CALs (23.6%), and 29 patients (13.2%) showed incomplete KD. The patients with CALs had a higher mean age, longer total fever duration, and higher rate of IVIG non-responsiveness. The patient group with severe skin lesions showed a higher mean age (P<0.001), more prolonged fever duration (P=0.041), higher frequency of CALs (P=0.033), higher WBC, neutrophil, and neutrophil-to-lymphocyte ratio levels, compared to the patient group without severe skin lesions. The patients with arthritis had a tendency of further treatment with me thylprednisolone or infliximab. Conclusions: The frequency of CALs was higher in patient group with severe skin lesions. Our results suggest that the intensity of clinical signs of KD such as skin rash, cervical lymphadenopathy and possibly arthritis may be associated the risk of CALs.
Abstract
Purpose: Kawasaki disease (KD) shows a variety of clinical signs of multi-system involvement, including clinical diagnostic criteria. It is unknown that the severity of the clinical signs is associated with the risk of coronary artery lesions (CALs). We wanted to evaluate clinical characteristics and the risk of CALs in the patient groups who had severe skin lesions or those with arthritis. Methods: We retrospectively reviewed the medical records of 220 KD patients who were treated with intravenous immunoglobulin (IVIG). We compared clinical and laboratory data between the group with severe skin lesions (n=52) and those with mild or no skin lesions (n=168), and between the group with arthritis (n=6) and those without arthritis (n=214). Results: The mean age of total patients was 2.23±1.87 years of age, and the male-to-female ratio was 1.5:1 (138/82). Among 220 patients, 52 patients had CALs (23.6%), and 29 patients (13.2%) showed incomplete KD. The patients with CALs had a higher mean age, longer total fever duration, and higher rate of IVIG non-responsiveness. The patient group with severe skin lesions showed a higher mean age (P<0.001), more prolonged fever duration (P=0.041), higher frequency of CALs (P=0.033), higher WBC, neutrophil, and neutrophil-to-lymphocyte ratio levels, compared to the patient group without severe skin lesions. The patients with arthritis had a tendency of further treatment with me thylprednisolone or infliximab. Conclusions: The frequency of CALs was higher in patient group with severe skin lesions. Our results suggest that the intensity of clinical signs of KD such as skin rash, cervical lymphadenopathy and possibly arthritis may be associated the risk of CALs.
참고문헌 (24)
- Gong WK, "Arthritis presenting during the acute phase of Kawasaki disease", J Pediat, 148, pp.800~805 (2006)
- Kim JS, "Pathogenesis of Kawasaki disease", J Korean Pediatr Heart, 9, pp.284~287 (2005)
- Newburger JW, "Diagnosis, treatment, and longterm 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", Pediatrics, 114, pp.1708~1733 (2004)
- Mathes EF, "A four year old boy with fever, rash, and arthritis", Semin Cutan Med Surg, 26, pp.179~187 (2007)
- 이경일, "Kawasaki Disease: Laboratory Findings and an Immunopathogenesis on the Premise of a “Protein Homeostasis System”", Yonsei Medical Journal, 53(2), pp.262~275 (2012), 연세대학교의과대학
- Kanegaye JT, "Lymph-node-first presentation of Kawasaki disease compared with bacterial cervical adenitis and typical Kawasaki disease", J Pediatr, 162, pp.1259~1263 (2013)
- Vecchietti G, "Severe eczematous skin reaction after high-dose intravenous immunoglobulin infusion: report of 4 cases and review of the literature", Arch Dermatol, 142, pp.213~217 (2006)
- Falcini F, "Severe cutaneous manifestations in a child with refractory Kawasaki disease", Rheumatology, 45, pp.1444~1445 (2006)
- Hicks RV, "Arthritis in Kawasaki syndrome: further characterization", Arthritis Rheum Suppl, 25, pp.S18~ (1982)
- Duzova A, "An unusual pattern of arthritis in a child with Kawasaki syndrome", Clin Rheumatol, 23, pp.73~75 (2004)
- Jen M, "Cervical spine and temporomandibular joint arthritis in a child with Kawasaki disease", Pediatrics, 118, pp.e1569~e1571 (2006)
- Yeung RS, "Phenotype and coronary outcome in Kawasaki's disease", Lancet, 369, pp.85~87 (2007)
- Arjunan K, "Coronary artery caliber in normal children and patients with Kawasaki disease but without aneurysms: an echocardiographic and angiographic study", J Am Coll Cardiol, 8, pp.1119~1124 (1986)
- Ueno K, "Circulating platelet-neutrophil aggregates play a significant role in Kawasaki disease", Circ J, 79, pp.1349~1356 (2015)
- Ha KS, "Value of neutrophil-lymphocyte ratio in predicting outcomes in Kawasaki disease", Am J Cardiol, 116, pp.301~306 (2015)
- Kwan YW, "Pustulo-vesicular skin eruption in a child with probable Kawasaki disease", Eur J Pediatr, 164, pp.770~771 (2005)
- Vierucci F, "Consolini R. Erythema multiforme as first sign of incomplete Kawasaki disease", Ital J Pediatrics, 39, pp.11~ (2013)
- Passeron T, "Kawasaki disease with exceptional cutaneous manifestations", Eur J Pediatr, 161, pp.228~230 (2002)
- Lee KY, "Arthritis in Kawasaki disease after responding to intravenous immunoglobulin treatment", Eur J Pediatr, 164, pp.451~452 (2005)
- Hicks RV, "Kawasaki syndrome; rheumatic complaints and analysis of salicylate therapy", Arthritis Rheum, 22, pp.621~622 (1979)
- Lefèvre-Utile A, "Coronary artery abnormalities in children with systemic-onset juvenile idiopathic arthritis", Joint Bone Spine, 81, pp.257~259 (2014)
- Kumar S, "Systemic onset juvenile idiopathic arthritis with macrophage activation syndrome misdiagnosed as Kawasaki disease: case report and literature review", Rheumatol Int, 33, pp.1065~1069 (2013)
- Rigante D, "Incomplete Kawasaki syndrome followed by systemic onset-juvenile idiopathic arthritis mimicking Kawasaki syndrome", Rheumatol Int, 30, pp.535~539 (2010)
- 이경일, "A Common Immunopathogenesis Mechanism for Infectious Diseases: The Protein-Homeostasis-System Hypothesis", Infection and Chemotherapy, 47(1), pp.12~26 (2015), 대한감염학회