Diagnosis of Kawasaki Disease Presenting with Limited and Faint Principal Clinical Features

Yuichi Nomura,Ryo Kusubae,Hiromi Ikeda,Yoshikazu Kato,Naho Nakazaki,Kiminori Masuda,Masako Hirabayashi,Koji Sameshima,Yuta Mikami

doi:10.3390/rheumato2010004

Abstract

Background: We examined the characteristics of Kawasaki disease (KD) patients who presented with limited and faint principal clinical features. Methods: We retrospectively reviewed the clinical records of 62 KD patients who presented with limited and faint clinical features at admission. A clinical feature that was recognizable by even junior doctors was defined as a definite feature (d-Feature), and a feature that was faint and recognizable by only experienced doctors was defined as a faint feature (f-Feature). Results: At admission, 82% of patients presented with fever and ≤1 d-Feature. Two days later, the d-Features increased in number and diagnoses of KD were established in 32 patients with fever and ≥4 d-Features. In 30 patients with ≤3 d-Features, experienced doctors recognized f-Features and diagnosed KD in 22 patients because of fever and ≥4 features. Among eight patients with ≤3 features, experienced doctors diagnosed six patients as incomplete KD considering their faint abnormal echocardiographic findings. For the remaining two patients, experienced doctors decided to commence KD treatments considering the patients’ clinical course. Conclusions: Sufficient clinical experience is essential during the diagnosis of KD in patients presenting with limited and f-Features. Educational programs for junior doctors on how to recognize f-Features and evaluate faint abnormal coronary artery findings are necessary.

Highlights

We examined the characteristics of Kawasaki disease (KD) patients who presented with limited and faint principal clinical features
The aims of this study are to examine the characteristics of KD patients with limited and faint principal clinical features, and the usefulness of the iKD-algorithm in diagnosing those patients
We used the patients who were diagnosed with an infectious disease at admission and given antibiotics as their initial treatments because of their limited and faint principal clinical features

Summary

Introduction

We examined the characteristics of Kawasaki disease (KD) patients who presented with limited and faint principal clinical features. The diagnosis of KD is based on the presence of five or six principal clinical features (fever, conjunctivitis, oral changes, cervical lymphadenopathy, rash, erythema, and change of the extremities) according to the Japanese guidelines [1]. It is based on the presence of ≥5 days of fever and the presence of up to four of the five principal clinical features according to the guidelines of American Heart Association [2]. Since the principal clinical features other than fever cannot be measured and relatively subjective, it is not unusual for patients with KD to present with limited and faint principal clinical features at admission

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