| 英文摘要 |
A 5-year-old boy suffered from high fever up to 40 degrees with respiratory symptoms; diagnosis at an emergency department indicated bronchopneumonia and severe dehydration. The boy was then hospitalized and treated with antibiotics, but high fever remained persistent and was accompanied by skin rash, dry, fissured lip and other symptoms resembling those of Kawasaki disease. However, there was not enough evidence to support a diagnosis meeting the criteria of typical or atypical Kawasaki disease. After blood examination, urine analysis, cardiac sonography, and viral/bacterial culture, we discussed with the parents about the possibility of Kawasaki disease and its coronary and cardiac complications. The next day after the discussion, the parents agreed to have the boy accept the therapy of intravenous immunoglobulin at their own expense. Fortunately, the fever subsided the following day after one dose of IVIG, and the boy was discharged from the hospital after eight days (no fever for three days). Five days after discharge, left neck swelling and periungual desquamation were noted during follow-up at clinic. The latest symptoms, together with previous ones, met the four criteria for the diagnosis of typical Kawasaki disease. Follow-up cardiac sonography revealed trivial mitral and tricuspid regurgitation. The most severe complication of Kawasaki disease is cardiovascular disease. In the United States, children diagnosed with Kawasaki disease should receive IVIG within the first 10 days of becoming ill. The treatment is most efficacious when it occurs within 7 days of the illness. It should be noted that performing the treatment within 5 days of the illness does not appear to prevent cardiovascular complications more effectively than having the treatment between 5 to 7 days as the efficacy of the treatment is more directly associated with an increased need for repeat treatment with IVIG. Long-term management and follow-up of Kawasaki disease depends on the severity and extent of coronary aneurysm or other cardiovascular complications developed during the acute phase. |
