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Correspondence

Indian Pediatr 2015;52: 443-444

Recurrence of Kawasaki Disease: Authors’ Reply

 

Pramila Verma

Department of Pediatrics, Peoples campus,Bhanpur, Bhopal, India.
Email: drpramilav@yahoo.com

    


We agree that during the second episode, coronary arteries were normal and rise in acute phase reactants was not very impressive in our patient. However, our case satisfied the criteria of incomplete Kawasaki disease during recurrence [1,2].

1. In our case, peeling of skin of sole occurred 2-3 weeks after the acute illness, that further supported the diagnosis, and does not indicate that skin peeling was mandatory for diagnosing the Kawasaki disease.

2. Broderick, et al. [3] reported recurrent fever in four patients with a history of Kawasaki disease. They had periodic fever ocurring at regular intervals (2-6 weeks) and two of them were also having aphthous stomatitis. Fever was associated with rash in two children, but skin desquamation was missing in all these children with recurrent fever. In our child, there was no such history. However, we agree that recurrent fever syndromes should be considered, and needs to be excluded before labelling the case as recurrent Kawasaki disease.

3. In scarlet fever, the skin may start to peel even during the febrile stage. This peeling starts cephalo-caudally, and lastly palms and soles.  In Kawasaki disease, sheet like skin peeling is characteristically limited to the palms and soles, as in our case. We agree that skin desquamation is not pathognomonic of Kawasaki disease.

4. It is true that disease recurrence results in additional coronary artery involvement, but we had administered intravenous immunoglobulins early in the course of disease that probably prevented coronary artery involvement [4].

References

1. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. American Heart Association Scientific Statement – Diagnosis, treatment, and long-term management of Kawasaki disease. Circulation. 2004;110:2747-71.

2. Witt MT, Luann ML, Bohnsack JF, Young PC. Kawasaki disease: More patients are being diagnosed who do not meet American Heart Association criteria. Pediatrics. 1999;104:10.

3. Broderick L, Tremoulet AH, Burns JC, Bastian JF, Hoffman HM. Recurrent fever syndromes in patients after recovery from Kawasaki syndrome. Pediatrics. 2011; 127:e489-93.

4. Rowley AH, Duffy CE, Shulman ST. Prevention of giant coronary artery aneurysms in Kawasaki disease by intravenous gammaglobulin therapy. J Pediatr. 1988;113:290-4.

 

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