Kawasaki Disease: A Clinical Case with Dramatic Presentation: A Case Report

Abstract

We report a rare case of Kawasaki disease in a 3-and-1/2-year-old child admitted in hospital with cardiac manifestation presented with complaint of on-and-off severe irritability, agitation due to chest pain since 20 days, and also had respiratory distress which was noticed just 5 days before admission. Child had no history of cardiac problem had history of fever, duration of about 7 days occurred on-and-off as three episodes over a period of 4 weeks without any cause. First child condition was identified by echocardiography which provoked by ECG (ST-T wave) changes and Trop-I positive result. Echocardiography revealed dramatic picture of Kawasaki disease in aortic root site-Coronary aneurysm with ejection fraction of 35–45%. Again detailed child history collected to rule out signs and symptoms of Kawasaki disease. History of skin rashes, especially on trunk, erythematic lesion on lips and oral mucosa, during fever episode, unilateral cervical lymphadenopathy. These all supported the diagnosis of classical Kawasaki disease type. Then child admitted immediately, and treatment started with intravenous immunoglobulin infusion over 48 hours. Other supportive management like beta-blockers, ACE Inhibitors, nitrates, antipyretics given. Then child undergone imaging study CT angiography to rule out the picture of coronary artery. It revealed multiple aneurysm and thrombus formation. So, heparin infusion started along with oral anticoagulant therapy. Patient hospital stay was not complicated as such disease characteristics. Child very well stabilized with supportive therapy. Meanwhile child had 2 episodes of fever managed with antipyretic and occasional episode of irritability, agitation due to chest pain managed with usual medicine but it lasts for only 2–5 minutes (not as before) managed with usual medicines. Meanwhile Childs PT, INR value was not improving with a citron, so changed into warfarin then PT, INR started maintaining around expected value. So, child discharged with Inj. Clexane 0.13 ml subcutaneously BD, Betaloc, Envas, Ecosprin, warfarin, Sorbitrate. Child has to come for first follow-up after 7 days.