Kawasaki disease is an acute febrile illness, also known as mucocutaneous lymph node syndrome. It predominantly affects children between the ages of six months and two years, and usually less than five years of age. Asian children are at higher risk due to genetic predisposition. The male-female ratio is 1.5:1. Males are more frequently affected and are also at a greater risk of developing coronary artery aneurysms.
Kawasaki disease has been associated with infectious agents (i.e., Epstein-Barr virus, herpes virus, and streptococcus), dust mites, carpet shampoo, and septic water. There are no specific diagnostic tests for Kawasaki disease. (Table 1). buy generic levitra
There are three phases in the clinical course of untreated Kawasaki disease. First is the acute febrile phase, which lasts one-to-two weeks and consists of the diagnostic criteria along with anorexia, irritability, hepatic dysfunction, and aseptic meningitis. Second is the subacute phase, which lasts two-to-four weeks and consists of thrombocytosis, arthritis and desquamation of the hands and feet. Fever, rash, and lym-phadenopathy resolve, and conjunctivitis and irritability may persist. At this time, patients are at greatest risk for coronary artery thrombosis. Finally, the convalescent phase begins when the clinical signs have resolved and the platelet count and sedimentation rate returns to normal. This phase usually occurs within six-to-10 weeks.
The case presented is typical of Kawasaki disease in the way the disease evolved with the clinical signs
Table 1. Diagnostic Criteria for Kawasaki Disease
Fever for at least five days plus four of the following:
1. Nonexudative bulbar conjunctival injection
2. Erythematous mouth and pharynx, and/or strawberry tongue, and/or red, cracked lips
3. Generalized erythematous rash
4. Swelling and erythema of the hands and feet followed by desquamation
5. Cervical lymphadenopathy with at least one node greater than 1.5 cm
and symptoms but atypical with respect to the patient’s postpartum status and her response to IV antibiotic therapy. This appears to be the first perinatal case of Kawasaki disease.
There have been five reported cases of Kawasaki disease and pregnancy in the English literature. All of these cases described patients who had Kawasaki disease during childhood and addressed how the sequelae of coronary artery aneurysms were managed during pregnancy and delivery. The first case described the successful pregnancy and delivery of a patient on low-dose aspirin who had two coronary artery aneurysms. Another report described a case of a successful pregnancy and delivery nine years after coronary artery bypass grafting for Kawasaki coronary artery disease. The third case described a successful pregnancy and delivery with a patient who had a coronary artery aneurysm treated with heparin anticoagulant therapy during pregnancy. The fourth case described the successful use of epidural anesthesia for the caesarean section of a patient with a childhood history of Kawasaki disease. Finally, the fifth case describes a patient who had a peripartum myocardial infarction from presumed Kawasaki disease.
The patient presented in this case was 21 years old and four weeks postpartum, with an initial presentation of a one-week history of fever and rash, which had initially responded to intravenous antibiotic therapy. During her first hospitalization, several conditions were considered. The differential diagnosis included toxic shock syndrome, septic shock, scarlet fever, Stevens Johnson syndrome, hypersensitivity reaction, folliculitis, endometritis, and Kawasaki disease. The patient was treated with the working diagnosis of toxic shock syndrome, but the lack of multisystem involvement and the laboratory results did not fulfill the criteria to make the diagnosis of toxic shock syndrome. She responded to one week of supportive care and IV antibiotic therapy, followed by one week of remission until the fever returned, the rash progressed, and the common features of Kawasaki disease began to evolve. Subsequently, she fulfilled more than the minimum criteria needed to make the diagnosis of Kawasaki disease. canada pharmacy mall
Generally, the clinical signs of Kawasaki disease tend to evolve with time and do not respond to antibiotics. Due to the patient’s response to IV antibiotics, the diagnosis of Kawasaki disease appeared to be less likely. Physicians who consider Kawasaki disease in the differential diagnosis of patients should maintain close follow-up to assure that the patients’ clinical signs and symptoms resolve.