六個月大嬰兒不完全川崎病之治療經驗分享

Treatment Experience of Incomplete Kawasaki Disease in a Six-Month-Old Infant

川崎病（Kawasaki Disease, KD）是一種系統性疾病，其特徵包括發燒、結膜炎、黏膜炎、皮疹、四肢變化和頸部淋巴結腫大。這些發現是川崎病診斷標準的基礎。不符合典型標準的患者可能患有不完全川崎病（Incomplete KD）。近年是用來描述此病不完全表現的狀況，不管是否出現冠狀動脈併發症并以不完全川崎病。不完全川崎病侵犯冠狀動脈風險相似，甚至可能更高。然而，不完全川崎病的診斷具有挑戰性，尤其是在嬰幼兒之中往往會被延誤。為了診斷不完全川崎病的病例，已制定了多種判讀方式及診斷流程，如臨床、心臟超音波和實驗室特徵。我們在此報告一例6個月大女嬰診斷為不完全川崎病IKD的病例。該病患在發燒第5天，我們根據診斷標準，及時診斷出IKD並給予免疫球蛋白治療。兒科醫師在臨床上高度懷疑川崎病時，即使發燒期未滿五天，也應考慮川崎病的可能性，積極爭取治療機會，特別是在6個月或以下的嬰幼兒。我們藉由此病例與讀者分享治療經驗，並強調早期診斷和治療在預防冠狀動脈併發症中的重要性。

Kawasaki disease (KD) is a systemic inflammatory vasculitis characterized by fever, conjunctivitis, mucosal inflammation, skin rash, changes in the extremities, and cervical lymphadenopathy. These clinical features form the basis of the diagnostic criteria for KD. Patients who do not meet the classic diagnostic criteria may be classified as having incomplete Kawasaki disease (IKD). In recent years, the term IKD has been used to describe cases with incomplete clinical manifestations, regardless of the presence of coronary artery involvement. Importantly, the risk of coronary artery complications in IKD is comparable to, and may even exceed, that observed in classic KD. However, the diagnosis of IKD remains challenging and is often delayed, particularly in infants and young children. To aid in early identification, several diagnostic algorithms incorporating clinical features, echocardiographic findings, and laboratory parameters have been developed. Based on established diagnostic criteria, we report the case of a six-month-old female infant diagnosed with IKD on the fifth day of fever who was promptly treated with intravenous immunoglobulin. When a strong clinical suspicion of KD is present, pediatricians should consider the diagnosis even before five days of fever have elapsed and initiate treatment as early as possible, especially in infants aged six months or younger. This case highlights the critical importance of early recognition and timely intervention in preventing coronary artery complications.