Enfermedad de Kawasaki: Cuadro clínico, exámenes de laboratorio y lesiones coronarias

Abstract

Kawasaki disease (KD) is a systemic acute vasculitis of unknown etiology that mainly (80%) affects patients under 5 years of age. KD presents with fever, bilateral non-purulent conjunctivitis, oral mucosa changes, cervical adenopathy, cutaneous changes in extremities and unspecific exanthema. Opportune diagnosis of KD is a challenge for clinicians, mainly because there are no specific tests, and clinical criteria originally described in 1967 are still valid. Laboratory changes in the acute phase of the disease are not specific nor diagnostic. Objectives: To describe the clinical features, laboratory findings, treatment employed and development of coronary artery aneurysms in the acute phase of patients with Kawasaki Disease (KD) treated in a tertiary care children's hospital in Mexico City. Methods: Retrospective and observational study in patients with diagnosis of Kawasaki Disease treated from August 1995 to December 2013. Information gathered included patient demographics, clinical features, laboratory results, treatment and echocardiographic findings in the acute phase of the disease. Results: We studied 338 cases of KD in 322 patients. Mean age at diagnosis was 38.94 ± 36.53 months, (range from 2 to 200 months). 66.9% of our patients were male with a male/female ratio of 2:1. Complete KD was diagnosed in 82.2% of our cases. 298 of the cases received intravenous immunoglobulin (IVIG). In 287 cases the fever resolved after 48 hours of administration of IVIG and only 12 cases required a second dose of IVIG. In the 1995 to 2003 period KD was diagnosed in 48 patients and 22 cases developed coronary artery lesions (45.8%), from 2004 to 2008 KD was diagnosed in 108 patients and 61 cases presented with coronary artery aneurysms (56.5%) and finally, in the 2009 to 2013 period, 182 cases of KD were diagnosed and 52 cases developed coronary artery aneurysms (28.61%). In the overall series, 4 patients died from cardiac complications in the acute phase of the disease. Conclusion: Diagnosis of KD is becoming more frequent and with an early recognition and prompt treatment, the development of coronary artery aneurysms is diminished.