Abstract O.08: Rashless Kawasaki Disease (KD): Colorado’s Experience

Abstract

Objective: Published studies describe Incomplete KD, but rashless KD has not been well characterized. We describe a 10 year experience with rashless KD patients, diagnosed based on the presence of a compatible illness and coronary artery lesions (CALs). Methods: We prospectively collected cases of rashless KD with CALs diagnosed at Children’s Hospital Colorado from 7/1/2004-6/30/2014. Patient charts were reviewed for demographic, clinical, laboratory, and diagnostic information. Results: 11 patients were identified (median age 3.7 yrs), representing 10.3% (11/107) of all KD patients with CALs diagnosed during the same time period. Diagnosis was made on median day of illness (DOI) 8 (range 4-17 days), and patients had a median of 4 (range 2-7) healthcare contacts prior to diagnosis. All patients (100%) had the presence or history of conjunctival injection and 8/11 (72.7%) had oral changes. Five patients had only 2 major clinical features in addition to fever; 1 patient had one. All patients had very elevated inflammatory markers. Infectious Disease consultants suspected KD and recommended treatment prior to echocardiogram (ECHO) results in 8/11 (72.7%), recommended treatment if ECHO abnormal in 2/11 (18.1%), and in 1/11 (9.2%) KD was thought to be unlikely, but the diagnosis was made by ECHO. Conclusions: 10.3% of KD patients with CALs at our institution presented without a rash. As rash is often considered a defining characteristic of KD, some children with rashless KD are likely not being identified and treated. Providers should consider the diagnosis of KD in patients with unexplained fever, conjunctivitis, and elevated inflammatory markers.