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Clinical fetures of kawasaki disease in school-aged children

Korean Journal of Pediatrics 2007;50(3):292-297.
Published online March 15, 2007.
Clinical fetures of kawasaki disease in school-aged children
Eun Young Park, Ji Hye Kim, Hae Soon Kim, Sejung Sohn
Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
학동기 아동에서의 가와사끼병의 임상 특징
박은영, 김지혜, 김혜순, 손세정
이화여자대학교 의과대학 소아과학교실
Correspondence: 
Hae Soon Kim, Email: hyesk@ewha.ac.kr
Abstract
Purpose
: Kawasaki disease (KD) rarely occurs in school-aged children. We clarified the characteristics of KD in this age group to provide tips for a high index of suspicion.
Methods
: Features of 38 patients with KD who were 7 years of age or older were retrospectively reviewed.
Results
: The incidence of the KD patients ≥7 years was 4.9 percent. The ratio of male to female was 2.5:1. Of the 38 patients, nine patients (24.0 percent) were diagnosed with typical KD and 29 patients (76.0 percent) with incomplete KD. In incomplete KD patients, cervical lymphadenopathy (69.0 percent) occurred most frequently, followed by conjunctival injection (62.0 percent) and polymorphous rash (45.0 percent). These patients occasionally presented with other additional symptoms including abdominal pain, headache, vomiting and arthralgia. Incomplete KD was initially diagnosed as cervical lymphadenitis (34.0 percent), viral infection (14.0 percent), scarlet fever (7.0 percent), meningitis (7.0 percent), and Kikuchi disease (7.0 percent). Coronary complications were noted in 15 patients (39.0 percent). Of the 37 patients treated with intravenous immunoglobulin, five (14.0 percent) were resistant to the therapy and all had coronary abnormalities.
Conclusion
: Most patients with KD ≥7 years of age have incomplete presentations. They tend to have a higher incidence of initial presentations of unilateral neck mass and coronary artery involvement. In school-aged children, fever and cervical lymphadenitis or suspected neck infection unresponsive to intravenous antibiotics should signal the possibility of KD. A high index of suspicion and prompt treatment is essential in this age group of patients.
Key Words: Kawasaki disease , Children


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