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Case Reports Indian Pediatrics 2000;37: 1264-1265. |
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Kawasaki Disease in Calcutta |
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Kawasaki disease is an acute febrile illness of unknown etiology affecting infants and young children mostly below 5 years(1). It was first reported in Japanese children by Tomisaku Kawasaki in 1967. There are several reports from India(2,4,5) in recent times. We would like to share our experience of two cases of Kawasaki disease which were clinically diagnosed and treated with intravenous immunoglobulin with full recovery.
The important clinical features of two cases are listed in Table I. Both the children were males and aged less than 5 years. Both the cases were admitted with moderate to high fever of 5 days duration associated with extreme irritability and a maculopapular rash prominent over trunk as compared to extremities. Vomiting and diarrhea was a predominant symptom in one of them.
On examination both had bilateral non suppurative conjunctivitis, dry cracked erythematous lips and congested pharynx. One patient had significant cervical lymphadenopathy. Both of them did not have hepatosplenomegaly. Non pitting edema was present from very beginning in one of them but appeared later (10th day) in the other. Periungual desquamation appeared on the 12th day in one and 15th day of illness in the other one. The important laboratory data are given in Table II. Both the cases showed mild anemia with a high ESR. One patient had normal and the other one a high leukocyte count. The high leukocyte count was due to increased polymorphonuclear cells. The platelet count was normal in early part of illness but increased subsequently (3,20,000/cumm in one and 3,60,000 cumm in the other one was considered high as per our laboratory standards). C-reactive protein was increased in both the cases. ECG and Echocardiography did not reveal any abnormality.
Both the cases weighing 10 and 8 kg respectively received 2.5 g of intravenous gammaglobulin (approximately 250-300 mg/kg/day) for a duration of 5 days. Aspirin was given 100 mg/kg/day in one patient but the other one owing to significant abdominal distension was given a lower dose of 50 mg/kg/day. After 7 days, both were maintained on aspirin 5 mg/kg/day for 6 months. The response in both the cases was dramatic with appearance of well being after 24 hours and subsidence of fever and other symptoms within 48 hours. Cardiac complica-tions were absent during acute stage. The patients were followed up clinically and with echocardiography at monthly intervals for 6 months and were found normal.
Both the cases diagnosed as Kawasaki disease fulfilled the internationally accepted criteria(6). Age and male preponderance conforms to other reports(2,5) except diarrhea in one of the case and absence of a very high platelet count which though according to our laboratory standards was at higher level. Similar platelet counts have been reported earlier(4). We could not treat these patients with the recommended dose of intravenous gamma-globulin of 2 g/kg/day as a single dose or 400 mg/kg/day for 4 days(6,7) because of financial constraints and available strength of commercial preparations. Our treatment protocol for 5 days was guided by some workers(4) who have used it for 5 days and at a low dose (200 mg/kg/day for 3-5 days) in cases without cardiac involvement. The recovery of these patients with such doses supports the dosage used by some workers(4) though the sample has been too small.
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