J Rheum Dis.  2020 Jan;27(1):68-72. 10.4078/jrd.2020.27.1.68.

Impending Cardiac Tamponade and Hemorrhagic Pleural Effusion as Initial Presentations of Incomplete Kawasaki Disease: A Case Report

Affiliations
  • 1Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. sirbe@naver.com
  • 2Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.

Abstract

Kawasaki disease (KD) is an acute febrile illness that is characterized by systemic inflammation usually involving medium-sized arteries and multiple organs during the acute febrile phase, leading to associated clinical findings. The diagnosis is based on the principal clinical findings including fever, extremity changes, rash, conjunctivitis, oral changes, and cervical lymphadenopathy. However, KD diagnosis is sometimes overlooked or delayed because other systemic organ manifestations may predominate in acute phase of KD. As a cardiovascular manifestation, an acute pericarditis usually shows a small pericardial effusion, but large pericardial effusion showing clinical signs of cardiac tamponade is very rare. Here, we described a case of incomplete KD presenting with impending cardiac tamponade, and recurrent fever and pleural effusion.

Keyword

Cardiac tamponade; Pleural effusion; Mucocutaneous lymph node syndrome

MeSH Terms

Arteries
Cardiac Tamponade*
Conjunctivitis
Diagnosis
Exanthema
Extremities
Fever
Inflammation
Lymphatic Diseases
Mucocutaneous Lymph Node Syndrome*
Pericardial Effusion
Pericarditis
Pleural Effusion*

Figure

  • Figure 1 Frontal view of the chest radiograph shows cardiomegaly and pleural effusion at right thorax.

  • Figure 2 The echocardiographic apical four-chamber view (A) and parasternal short-axis view (B) show a massive pericardial effusion with impending cardiac tamponade.

  • Figure 3 Clinical course and treatment of this patient. KD: Kawasaki disease, PCD: pigtail catheter drainage, IVIG: intravenous immunoglobulin.


Reference

1. Kawasaki T, Kousaki F. Fabrile oculo-oro-cutaneo-acrodesquamatous syndrome with or without acute non-suppurative cervical lymphadenitis in infancy and childfood: clinical observations of 50 cases. Jpn J Allergol. 1967; 16:178–222. 225
2. Minich LL, Sleeper LA, Atz AM, McCrindle BW, Lu M, Colan SD, et al. Pediatric Heart Network Investigators. Delayed diagnosis of Kawasaki disease: what are the risk factors? Pediatrics. 2007; 120:e1434–e1440.
Article
3. McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young. Council on Cardiovascular and Stroke Nursing. Council on Cardiovascular Surgery and Anesthesia. Council on Epidemiology and Prevention. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017; 135:e927–e999.
Article
4. Dahlem PG, von Rosenstiel IA, Lam J, Kuijpers TW. Pulse methylprednisolone therapy for impending cardiac tamponade in immunoglobulin-resistant Kawasaki disease. Intensive Care Med. 1999; 25:1137–1139.
Article
5. Ozdogu H, Boga C. Fatal cardiac tamponade in a patient with Kawasaki disease. Heart Lung. 2005; 34:257–259.
Article
6. Zulian F, Falcini F, Zancan L, Martini G, Secchieri S, Luzzatto C, et al. Acute surgical abdomen as presenting manifestation of Kawasaki disease. J Pediatr. 2003; 142:731–735.
Article
7. Rosenfeld EA, Corydon KE, Shulman ST. Kawasaki disease in infants less than one year of age. J Pediatr. 1995; 126:524–529.
Article
8. Kanegaye JT, Van Cott E, Tremoulet AH, Salgado A, Shimizu C, Kruk P, et al. Lymph-node-first presentation of Kawasaki disease compared with bacterial cervical adenitis and typical Kawasaki disease. J Pediatr. 2013; 162:1259–1263.
Article
9. Thabet F, Bafaqih H, Al-Mohaimeed S, Al-Hilali M, Al-Sewairi W, Chehab M. Shock: an unusual presentation of Kawasaki disease. Eur J Pediatr. 2011; 170:941–943.
Article
10. Ravelli A, Minoia F, Davì S, Horne A, Bovis F, Pistorio A, et al. Paediatric Rheumatology International Trials Organisation. Childhood Arthritis and Rheumatology Research Alliance. Pediatric Rheumatology Collaborative Study Group. Histiocyte Society. 2016 Classification criteria for macrophage activation syndrome complicating systemic juvenile idiopathic arthritis: a European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Ann Rheum Dis. 2016; 75:481–489.
11. Mizuta M, Shimizu M, Inoue N, Kasai K, Nakagishi Y, Takahara T, et al. Serum ferritin levels as a useful diagnostic marker for the distinction of systemic juvenile idiopathic arthritis and Kawasaki disease. Mod Rheumatol. 2016; 26:929–932.
Article
12. Hamada H, Terai M, Honda T, Kohno Y. Marked pleural and pericardial effusion with elevated Vascular Endothelial Growth Factor production: an uncommon complication of Kawasaki disease. Pediatr Int. 2005; 47:112–114.
Article
13. Voynow JA, Schanberg L, Sporn T, Kredich D. Pulmonary complications associated with Kawasaki disease. J Pediatr. 2002; 140:786–787.
Article
14. Hirono K, Kemmotsu Y, Wittkowski H, Foell D, Saito K, Ibuki K, et al. Infliximab reduces the cytokine-mediated inflammation but does not suppress cellular infiltration of the vessel wall in refractory Kawasaki disease. Pediatr Res. 2009; 65:696–701.
Article
15. Jinkawa A, Shimizu M, Nishida K, Kaneko S, Usami M, Sakumura N, et al. Cytokine profile of macrophage activation syndrome associated with Kawasaki disease. Cytokine. 2019; 119:52–56.
Article
16. Kone-Paut I, Cimaz R, Herberg J, Bates O, Carbasse A, Saulnier JP, et al. The use of interleukin 1 receptor antagonist (anakinra) in Kawasaki disease: a retrospective cases series. Autoimmun Rev. 2018; 17:768–774.
Article
17. Strunk J, Bundke E, Lange U. Anti-TNF-alpha antibody Infliximab and glucocorticoids reduce serum vascular endothelial growth factor levels in patients with rheumatoid arthritis: a pilot study. Rheumatol Int. 2006; 26:252–256.
18. Latino GA, Manlhiot C, Yeung RS, Chahal N, McCrindle BW. Macrophage activation syndrome in the acute phase of Kawasaki disease. J Pediatr Hematol Oncol. 2010; 32:527–531.
Article
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