川崎氏症發燒合併呼吸道症狀：個案報告

A 5-year-old Boy Undergoing High Fever up to 40 Degrees with Respiratory Symptoms for Three Days: A Case Report

一位5歲男孩高燒至40度合併呼吸道症狀，經急診診斷支氣管肺炎並嚴重脫水，住院開始抗生素治療，但治療過程仍持續高燒，並陸續出現紅疹、嘴唇紅腫乾裂等疑似川崎氏症的典型症狀，但經抽血、尿液檢查、心臟超音波檢查及細菌培養後，尚未符合典型或非典型川崎氏症的診斷準則。與父母討論川崎氏症的可能性及其會造成冠狀動脈和心臟的併發症。隔天病童父母即自費施打免疫球蛋白。隔天就開始退燒，出院後門診追蹤發現指甲緣脫屑，則就符合四項的典型川崎氏症診斷準則。門診心臟超音波追蹤報告呈現極輕微二尖瓣和三尖瓣閉鎖不全。川崎氏症最令人擔心的是心血管疾病的併發症，在美國，所有被診斷川崎氏症的孩童，應該要在發病10天內施打免疫球蛋白，若在7天內能施打，則治療效力最好，而5天內施打並不會提高避免心血管併發症的效力，所以建議在發病後5-7天施打免疫球蛋白，如效果不彰，可在10天內再追加第二劑免疫球蛋白。若在急性期已造成的心血管併發症，建議定期追蹤及藥物控制。

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.