Atypical Kawasaki Disease- Experience in Hong Kong

Abstract

Introduction: Infants with atypical Kawasaki Disease always posed a diagnostic difficulty to cardiologist and literature has suggested that infants with Kawasaki Disease had a higher complication rate. A retrospective review of atypical Kawasaki disease from July 1994 to June 2000 was carried out to study the incidence and coronary complication rate among patients with atypical Kawasaki Disease. Methods: The hospital records of patients with Kawasaki diseases diagnosed between July 1994 to June 2000 were reviewed by members of Hong Kong Kawasaki Disease Study Group. Patients were identified as atypical Kawasaki disease if they have less than five of the diagnostic criteria after having excluded other possible causes. Results: A total of 72 cases of atypical Kawasaki disease were diagnosed from July 1994 to June 2000. Forty-five are males. Twenty-seven were females. M: F ratio 1.7: 1. Age of onset range from 0.2yr to 12.8yrs (mean 2.1yr; median 2.2yr). 39 of them are infants (54%; p< 0.0001). 56 (79%) received IVIG therapy (p =0.01). Coronary artery aneurysm developed in 25 cases (34.7%) of atypical Kawasaki Disease (p<0.0001). 15 (60%) of them were infants. 20 of the atypical cases with coronary aneurysm received IVIG therapy. Conclusion: We conclude that patients with atypical Kawasaki disease had a higher rate of coronary complication. Infants were associated with a higher rate of atypical presentation and coronary complication. Male sex and use of IVIG contribute no statistical significance in the development of coronary complication in atypical Kawasaki disease. However, patients with atypical Kawasaki disease had a significant lower incidence of receiving IVIG therapy when compared with typical Kawasaki presentation. This may be due to delay in diagnosis and treatment. A high index of suspicion and clinical assessment by cardiologist is recommended in the diagnosis and treatment of atypical Kawasaki disease especially among infants.