| Autor: |
Sanjay Raina, Iqbal, AP Singh, E Haworth |
| Rok vydání: |
2020 |
| Předmět: |
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| Zdroj: |
Paediatricians with expertise in cardiology special interest group (PECSIG). |
| DOI: |
10.1136/archdischild-2020-rcpch.7 |
| Popis: |
10 weeks old infant presented to emergency with 9 days history of fever. He was seen by G.P twice during this illness, initially the impression of viral illness was made and on second time child had 9 days of fever and looked miserable and lethargic so was referred to padiatrics emergency. There was no significant past medical history. No history of sick contacts and no recent travel. At presentation the child was febrile and irritable with no obvious source for fever. He was started on IV Ceftriaxone and Aciclovir. Initial bloods revealed profound leucocytosis (Total WBC 76, neutrophils 50.1) and CRP of 236, with serial blood films showing a reactive picture and left shift. Chest x-ray was clear, urine/blood cultures were negative and LP showed 8 WCC with negative cultures. After 72 hours of inpatient care the child was referred to tertiary centre in view persistent fever and irritability. In the tertiary Hospital, parents told that child had bloodshot eyes, puffy swollen feet and red lips. Child was started on IVIG 2 gm/kg and high dose aspirin. Child had echocardiography which showed right coronary artery (RCA) dilatation maximal at distal segment measuring 3.58 mm with Z-score of 8.86. RCA at mid-point and proximal segment measured 3.06 and 2.93 respectively with Z-score of 6.31 and 5.14 respectively. Left anterior descending artery measured 2.42 with Z-score of 4.27. During in-patient child was having on-going mild fever and in view of significant coronary dilatation child was started on low molecular weight heparin and also second line treatment with infliximab to which he responded well. Repeat echocardiography showed stable coronary dilatation. Kawasaki is a mucocutaneous lymph node syndrome with specific diagnostic features, having said that it seems to be a rarity to find all the features consistent with diagnosis. The age presentation, less than 6 month is a very uncommon reported finding in UK and the lack of any diagnostic features initially for Kawasaki except fever lasting for more than 5 days makes this case an important academic and learning standpoint for paediatric trainees. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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