Kawasaki Disease Shock Syndrome: A Challenging Diagnosis

Abstract

The authors present a clinical report of a previously healthy 4-year-old girl, admitted to a pediatric intensive care unit (PICU) presenting with a fluid-refractory shock. She was initially admitted in the pediatric emergency department with a history of fever and petechial rash and an initial diagnosis of invasive meningococcal disease was placed. During the PICU stay, acute myocarditis with episodes of supraventricular tachycardia and lateral and inferior wall myocardial ischemia, ileitis and serositis were noted. At 14th day of stay, she developed peeling on the hands and feet and, aneurysmatic ectasia of the coronary arteries were visualized in transthoracic echocardiography, allowing the diagnosis of Kawasaki disease shock syndrome (KDSS). The child improved after empirical treatment with antibiotics, intravenous immunoglobulin and corticosteroid therapy. She was started on antiplatelet therapy due to changes in the coronary arteries. Early recognition of KDSS can be challenging; however, a delayed diagnosis increases the risk of coronary changes and a fatal outcome. Int J Clin Pediatr. 2021;10(1):10-17 doi: https://doi.org/10.14740/ijcp425