SpringerLink
Log in

Lung parenchymal consolidation as an uncommon presentation and cause of delayed diagnosis in atypical Kawasaki syndrome

  • Case Report
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

We report three patients who initially showed prolonged fever, lung parenchymal consolidation and laboratory findings of pneumonia, and secondarily presented a clinical picture ascribed to Kawasaki syndrome. Two of these children developed coronary artery dilations, which regressed upon echocardiography after 12 months. In the case of infants showing broncho-pulmonary abnormalities with slow resolution, active inflammatory parameters and high fever persistence, pediatricians should consider atypical Kawasaki syndrome as a possible alternative diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, Committee on Rheumatic Fever, Endocarditis, Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association et al (2004) Diagnosis, treatment, and long-term 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 114:1708–1733. doi:10.1542/peds.2004-2182

    Article  PubMed  Google Scholar 

  2. Rowley AH, Shulman ST (2007) New developments in the search for the etiologic agent of Kawasaki disease. Curr Opin Pediatr 19:71–74. doi:10.1097/MOP.0b013e328012720f

    Article  PubMed  Google Scholar 

  3. Terai M, Shulman ST (1997) Prevalence of coronary artery abnormalities in Kawasaki disease is highly dependent on gammaglobulin dose but independent of salicylate dose. J Pediatr 131:888–893. doi:10.1016/S0022-3476(97)70038-6

    Article  PubMed  CAS  Google Scholar 

  4. Uziel Y, Hashkes PJ, Kassem E, Gottesman G, Wolach B (2003) “Unresolving pneumonia” as the main manifestation of atypical Kawasaki disease. Arch Dis Child 88:940–942. doi:10.1136/adc.88.10.940

    Article  PubMed  CAS  Google Scholar 

  5. Voynow JA, Schanberg L, Sporn T, Kredich D (2002) Pulmonary complications associated with Kawasaki disease. J Pediatr 140:786–787. doi:10.1067/mpd.2002.pd124772

    Article  PubMed  Google Scholar 

  6. Freeman AF, Crawford SE, Finn LS, López-Andreu JA, Ferrando-Monleón S, Pérez-Tamarit D et al (2003) Inflammatory pulmonary nodules in Kawasaki disease. Pediatr Pulmonol 36:102–106. doi:10.1002/ppul.10333

    Article  PubMed  Google Scholar 

  7. Kobayashi Y, Koike Y, Tokutomi T, Kuroki Y, Todoroki I (2006) Case 2: fever, rash and pulmonary involvement, diagnosis: Kawasaki disease. Acta Paediatr 95:1145–1148. doi:10.1080/08035250600686953

    Article  PubMed  Google Scholar 

  8. Sengler C, Gaedicke G, Wahn U, Keitzer R (2004) Pulmonary symptoms in Kawasaki disease. Pediatr Infect Dis J 23:782–784. doi:10.1097/01.inf.0000134313.86697.20

    Article  PubMed  Google Scholar 

  9. Umezawa T, Saji T, Matsuo N, Odagiri K (1989) Chest X-ray findings in the acute phase of Kawasaki disease. Pediatr Radiol 20:48–51. doi:10.1007/BF02010633

    Article  PubMed  CAS  Google Scholar 

  10. Falcini F, Cimaz R, Calabri GB, Picco P, Martini G, Marazzi MG et al (2002) Kawasaki’s disease in northern Italy: a multicenter retrospective study of 250 patients. Clin Exp Rheumatol 20:421–426

    PubMed  CAS  Google Scholar 

  11. Yasukawa K, Terai M, Shulman ST, Toyozaki T, Yajima S, Kohno Y et al (2002) Systemic production of vascular endothelial growth factor and fms-like tyrosine kinase-1 receptor in acute Kawasaki disease. Circulation 105:709–766. doi:10.1161/hc0602.103396

    Article  Google Scholar 

  12. Rowley AH, Baker SC, Shulman ST, Fox LM, Takahashi K, Garcia FL et al (2005) Cytoplasmic inclusion bodies are detected by synthetic antibody in ciliated bronchial epithelium during acute Kawasaki disease. J Infect Dis 192:1757–1766. doi:10.1086/497171

    Article  PubMed  Google Scholar 

  13. Rowley AH, Shulman ST, Garcia FL, Guzman-Cottrill JA, Miura M, Lee HL et al (2005) Cloning the arterial IgA antibody response during acute Kawasaki disease. J Immunol 175:8386–8391

    PubMed  CAS  Google Scholar 

  14. Ayusawa M, Sonobe T, Uemura S, Ogawa S, Nakamura Y, Kiyosawa N, Kawasaki Disease Research Committee et al (2005) Revision of diagnostic guidelines for Kawasaki disease (the 5th revised edition). Pediatr Int 47:232–234. doi:10.1111/j.1442-200x.2005.02033.x

    Article  PubMed  Google Scholar 

  15. Rosenfeld EA, Corydon KE, Shulman ST (1995) Kawasaki disease in infants less than 1 year of age. J Pediatr 126:524–529. doi:10.1016/S0022-3476(95)70344-6

    Article  PubMed  CAS  Google Scholar 

  16. Genizi J, Miron D, Spiegel R, Fink D, Horowitz Y (2003) Kawasaki disease in very young infants: high prevalence of atypical presentation and arteritis. Clin Pediatr 42:263–267. doi:10.1177/000992280304200310

    Article  Google Scholar 

  17. Anderson MS, Todd JK, Glodé MP (2005) Delayed diagnosis of Kawasaki syndrome: an analysis of the problem. Pediatrics 115:e428–e433. doi:10.1542/peds.2004-1824

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Cardarelli National Hospital, Via Cardarelli 9, 80131, Naples, Italy

    Francesco De Maddi & Paolo Siani

  2. Neonatology and Pediatrics Unit, Vico Equense-Sorrento Hospital, Vico Equense (NA), Italy

    Roberto Cinelli & Gianfranco Mazzarella

  3. Department of Pediatric Sciences, Università Cattolica Sacro Cuore, Rome, Italy

    Donato Rigante

Authors
  1. Francesco De Maddi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberto Cinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Donato Rigante
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gianfranco Mazzarella
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paolo Siani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco De Maddi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

De Maddi, F., Cinelli, R., Rigante, D. et al. Lung parenchymal consolidation as an uncommon presentation and cause of delayed diagnosis in atypical Kawasaki syndrome. Rheumatol Int 29, 1373–1376 (2009). https://doi.org/10.1007/s00296-008-0830-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-008-0830-2

Keywords

Search

Navigation