All issues > Volume 46(6); 2003

Original Article

J Korean Pediatr Soc. 2003;46(6):591-596. Published online June 15, 2003.

Clinical Characteristics of Kawasaki Disease in Infants Younger than 3 Months of Age

Soo Jeong SJ Lee¹, So Jung SJ Kim¹, Hae Soon HS Kim¹, Sejung SJ Sohn¹

¹Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea

Abstract

Purpose
: Kawasaki disease(KD) is rare in infants <3 months of age. In this younger group, the diagnosis may be delayed due to lack of most of the clinical criteria, resulting in a high risk of cardiac complications. We examined clinical characteristics in these patients for early recognition and treatment.
Methods
: We conducted a retrospective study on the infants with KD aged three months or younger treated at our hospital from January 1998 to July 2002.
Results
: Of a total of 291 patients treated during the study period, 11(3.8%) were three months old or younger. Of the 11 patients, 10 had atypical presentations. Infants had fewer of the accepted criteria, and the most common findings were fever(100%) and oral mucosal changes(72.7%). Erythema at the site of BCG inoculation was observed in six of the 11 patients(unknown in the remaining five). This feature proved a definite diagnostic clue in two patients in whom cardiac complications developed in the subacute phase. Cardiac complications were found in six patients(54.5%) : three had coronary dilatation, two had coronary wall irregularity, and one had mitral valve prolapse with regurgitation. Defervescence occurred within 1.1?.3 day in 10 of the 11 patients treated with intravenous immunoglobulin(IVIG) and one was given a second course of IVIG. Echocardiographic abnormality persisted in only one patient with mitral regurgitation at the 6-month follow-up.
Conclusion
: Most patients with KD younger than three months of age have atypical presentations and a high complication rate. For early diagnosis, erythema at the BCG inoculation site, if present, could be used as a valid diagnostic clue to atypical KD in this age group.

Keywords :Kawasaki disease, BCG, Infant