Abstract 16: A Clinical Study Of Older Children With Kawasaki Disease

Background: Kawasaki disease(KD) patients exhibiting a disease onset past infancy are likely to receive a delayed diagnosis, as it takes time for all major symptoms to manifest and the disease also includes many non-typical features. Most general pediatricians and infectious disease specialists may not consider KD in the differential diagnosis among schoolchildren. Objective: To examine the clinical features of KD in patients with school-age onset. Methods: Among a total of 650 patients who received a diagnosis of KD in groups Department of pediatrics, Kitasato University School of Medicine , Sagamihara Cooperation Hospital and Ebina General Hospital over the seven-year period from April 2007 to March 2014, we investigated schoolchildren 7 years of age or older. Using the patients’ medical records, we retrospectively assessed data for sex, age, duration of illness, symptoms, treatment effectiveness and coronary artery lesions. Results: Fourteen (2.2%) schoolchildren were identified (male: n=7, 50%). The median age was 8 years (oldest age: 12 years). The incomplete type was diagnosed in 4 cases (29%), and the typical type was diagnosed in 10 cases (71%). The median duration of illness was 5 days (range: 3-12 days). Five patients (36%) were diagnosed with lymphadenitis at the initial diagnosis. Two patients with Mycoplasma pneumonia and acute appendicitis received a delayed diagnosis of KD. Their symptoms included gastrointestinal symptoms, joint pain with headaches and muscle pain. Nine patients (64%) exhibited membranous desquamation. Two of these patients displayed swelling of the hands and feet at diagnosis. All 14 patients were first treated with intravenous immunoglobulin therapy (IVIG: 2 g/kg); only one patient was resistant. Two patients (14%) were diagnosed with transient coronary artery dilatation; however, no patients had coronary aneurysms. Conclusions: KD with a school-age onset is rare; however, the incidence of cardiovascular complications in such cases has been reported to be high. Therefore, providing an early diagnosis and appropriate therapy is necessary. Physicians should consider the possibility of KD in school-age children who present with a persistent fever.