WASHINGTON — Atypical and incomplete Kawasaki disease may be distinguished from other common childhood febrile illnesses by characteristic changes to the extremities, mucosa, conjunctiva, and blood laboratory values, Dr. Fernanda Falcini reported at a poster session of the annual meeting of the American College of Rheumatology.
In a chart review of 1,499 children discharged from the hospital with a diagnosis of Kawasaki disease (KD), 225 (15%) did not fulfill the Centers for Disease Control and Prevention's case definition criteria of KD. The CDC identifies KD patients as those having four of the following five clinical signs: rash, cervical lymphadenopathy of at least 1.5 cm in diameter, bilateral conjunctival injection, oral mucosal changes, and peripheral extremity changes.
Of those 225 patients, 172 had incomplete KD (median age 21 months) and 53 had atypical disease (median age 50 months), according to Dr. Falcini of the rheumatology unit in the department of pediatrics at the University of Florence (Italy).
Patients with incomplete KD did not meet all of the CDC case definition criteria, whereas atypical disease referred to patients who also had a problem that generally is not seen in KD.
Lip and oral redness, skin extremity changes, and nonexudative conjunctivitis occurred significantly more often among children with incomplete or atypical KD than in 55 children who had other febrile illnesses that mimic KD. These other illnesses were cytomegalovirus (in 21 children), adenovirus (16), systemic juvenile idiopathic arthritis (12), Epstein-Barr virus (5), and staphylococcal scalded skin syndrome (1).
The erythrocyte sedimentation rate and total platelet count of children with incomplete and atypical KD also were significantly higher than in children with other KD-mimicking illnesses. But children with febrile diseases other than KD were significantly more likely to have lymphadenopathy than were those with incomplete or atypical KD.
Coronary artery diseases, including dilatation and aneurysms, were detected only in patients with incomplete (47) or atypical KD (15), reported Dr. Falcini.