J Stapp1, G S Marshall. 1. Department of Pediatrics, University of Louisville School of Medicine, KY 40202, USA.
Abstract
BACKGROUND: The diagnosis of Kawasaki disease (KD) is made by fulfillment of clinical criteria. The dramatic effectiveness of intravenous immune globulin in this disease might lead to treatment of cases that do not meet those criteria. METHODS: A retrospective review was conducted of all cases of KD treated at Kosair Children's Hospital between January 1993 and July 1997. RESULTS: Fifty-six patients were identified. Demographic features were similar to reports from other regions of the country. Forty-eight children fulfilled criteria for typical or atypical KD and 8 (14%) did not. The latter children were not distinguished from those meeting criteria by standard laboratory test results. Echocardiographic abnormalities were found in 17 cases, including 3 with coronary artery aneurysms, but all abnormalities eventually resolved. CONCLUSIONS: The treatment of 14% of patients despite incomplete diagnostic criteria illustrates the tendency to be liberal in treatment decisions regarding KD. Whether this proportion of patients has a forme fruste of the illness that warrants treatment will await definitive biological markers for the syndrome.
BACKGROUND: The diagnosis of Kawasaki disease (KD) is made by fulfillment of clinical criteria. The dramatic effectiveness of intravenous immune globulin in this disease might lead to treatment of cases that do not meet those criteria. METHODS: A retrospective review was conducted of all cases of KD treated at Kosair Children's Hospital between January 1993 and July 1997. RESULTS: Fifty-six patients were identified. Demographic features were similar to reports from other regions of the country. Forty-eight children fulfilled criteria for typical or atypical KD and 8 (14%) did not. The latter children were not distinguished from those meeting criteria by standard laboratory test results. Echocardiographic abnormalities were found in 17 cases, including 3 with coronary artery aneurysms, but all abnormalities eventually resolved. CONCLUSIONS: The treatment of 14% of patients despite incomplete diagnostic criteria illustrates the tendency to be liberal in treatment decisions regarding KD. Whether this proportion of patients has a forme fruste of the illness that warrants treatment will await definitive biological markers for the syndrome.