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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- 1. Nakamura Y, Yanagawa H. The worldwide epidemiology of Kawasaki disease. Prog Pediatr Cardiol 2004;19:99-108
- 2. Kawasaki T. Pediatric acute mucocutaneous lymph node syndrome: clinical observation of 50 cases. Arerugi (Jpn J Allergy) 1967;16:178-222.
- 3. Yeung RS. Kawasaki disease: uptade on pathogenesis. Curr Opin Rheumatol 2010;22:551-60.
- 4. Ozen S, Ruperto N, Dillon MJ, Bagga A, Barron K, Davin JC, et al. EULAR/PreS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis 2006;65:936-41.
- 5. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and longterm management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004;110:2747-71.
- 6. Baker AL, Lu M, Minich LL, Atz AM, Klein GL, Korsin R, et al. Associated symptoms in the ten days prior to diagnosis of Kawasaki disease. J Pediatr 2009;154:592-5.
- 7. Rowley AH, Wolinsky SM, Relman DA, Sambol SP, Sullivan J, Terai M, et al. Search for highly conserved viral and bacterial nucleic acid sequences corresponding to an etiologic agent of Kawasaki disease. Pediatr Res 1994;36:567-71.
- 8. Rowley AH. The etiology of Kawasaki disease: superantigen or conventional antigen?. Pediatr Infect Dis J 1999;18:69-70.
- 9. Council on Cardiovascular Disease in the Young; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease; American Heart Association. Diagnostic guidelines for Kawasaki disease. Circulation 2001;103:335-6.
- 10. Sonobe T, Kawasaki T. Atypical Kawasaki disease. Prog Clin Biol Res 1987;250:367-78.
- 11. Gong GW, McCrindle BW, Ching JC, Yeung RS. Arthritis presenting during the acute phase of Kawasaki disease. J Pediatr 2006;148(6):800-5.
- 12. Umezawa T, Saji T, Matsuo N, Odagiri K. Chest x-ray findings in the acute phase of Kawasaki disease. Pediatr Radiol 1989;20:48-51.
- 13. Picazo M, Fernandez-Mentes J, Fabrega R, Calatayud A, Vazquez G, Ros M. Radiologic findings in the lungs of patients with Kawasaki disease. Radiologia 2006;48(1):14-8.
- 14. Lee MN, Cha JH, Ahn HM, Yoo JH, Kim HS, Sohn S, et al. Mycoplasma pneumoniae infection in patients with Kawasaki disease. Korean J Pediatr 2011;54(3):123-7.
- 15. Uziel Y, Hashkes PJ, Kassem E, Gottesman G, Wolach B.'Unresolving pneumonia" as the main manifestation of atypical Kawasaki disease. Arc Dis Child 2003; 88(10):940-2.
- 16. Yavuz T, Nisli K, Yılmaz C, Dindar A. Large pleural effusion necessitates tube drainage in a patient with Kawasaki disease. J Paediatr Child Health 2007;43(3):191-2.