Kawasaki disease: Clinical experience in a university hospital

Abstract

Objective: Kawasaki disease is an acute systemic vasculitis of unknown etiology. Its diagnosis is based on clinical criteria. This study aimed to describe Kawasaki disease cases treated at the University Hospital of Universidade de São Paulo, from January/2000 to June/2008. Methods: Among all patients admitted to the pediatric ward during this period, patients whose discharge ICD was Kawasaki disease were selected. A descriptive study was carried out by analyzing the records of these children. Results: 18 cases were found, with an average of 2.1 cases/ year. Patients varied from three to nine years old. The boys/ girls ratio was 1/1.25. Seventeen patients had previously been misdiagnosed with other diseases, being 2/3 of them scarlet fever. Prior to diagnosis, fever had persisted for five to 11 days. Nine patients showed four suggestive signs of Kawasaki disease, eight patients showed five signs, and one patient had two suggestive signs, which was considered as incomplete Kawasaki disease. Gammaglobulin was administered to 15 children (between the 6th-10th day of the disease), with 11 (73%) of them having no fever following the administration. The other ones had fever for up to 24 hours following gammaglobolin use. All patients were evaluated by echocardiograms, and three of them showed mild coronary aneurysm. Conclusions: Kawasaki disease is usually misdiagnosed, thereby delaying treatment and increasing the risk of heart.