Mustafa ÇAKAN, NURAY AKTAY AYAZ, GONCA KESKİNDEMİRCİ, Hamide Sevinç GENÇ, Helen BORNAUN

İyileşmeyen Pnömoni ile Başvuran Bir Atipik Kawasaki Hastaliği Olgusu

Kawasaki hastalığı çocukluk çağında sık gözlenen, nedeni bilinmeyen sistemik bir vaskülittir. Karakteristik bulguları ateş, polimorfik döküntü, konjonktivit, oral mukoza ve ekstremite değişiklikleri ve servikal lenfadenopatidir. En önemli morbidite ve mortalite nedeni kardiyak tutulumdur. Başlangıç döneminde öksürük ve burun akıntısı ile bulgu veren üst solunum yolu tutulumu göreceli olarak sık görülmesine karşın pnömoni şeklinde akciğer tutulumu ile seyretmesi son derece nadirdir. Olgu: On altı aylık erkek hasta uzamış ateş ve iyileşmeyen pnömoni nedeniyle kliniğimize sevk edildi. Akciğer grafisinde konsolidasyon saptanan olguda takipte Kawasaki hastalığı tanısı konuldu. Antibiyotik tedavisi ile klinik ve laboratuar bulgularında düzelme olmayan olguda tek doz intravenöz immü- noglobulin (2 gr/kg) uygulanması sonucu klinik ve röntgen bulgularında düzelme gözlendi. Sonuç: Uzamış ateş, antibiyotik tedavisi ile düzelmeyen pnömoni ve belirgin akut faz yanıtı olan olgularda Kawasaki hastalığı ayırıcı tanıda düşünülmelidir.

A Case of Atypical Kawasaki Disease Presenting with Unresolving Pneumonia

Kawasaki disease is a systemic vasculitis with unknown etiology that is common among children. Characteristic findings are fever, polymorphic rash, conjunctivitis, oral mucosa and extremity changes and cervical lymphadenopathy. The most important cause of morbidity and mortality is cardiac involvement. At the early stages of the disease, upper airway tract symptoms like coryza and cough are common. But lung parenchyme involvement as pneumonia is extremely rare. Case: A 16-months-old boy was admitted to our clinic due to prolonged fever and unresolving pneumonia. Consolidation was observed on the chest X-ray. On the follow up, the child was diagnosed as having Kawasaki disease. Clinical and laboratory remission could not be achieved by antibiotic treatment. Clinical and chest X-ray findings were normalized after one dose intravenous immunoglobulin infusion (2gr/kg). Conclusion: In patients with prolonged fever, unresolving pneumonia with antibiotic treatment and high acute phase reactants, Kawasaki disease should be in differential diagnosis.

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