Kawasaki disease in Port Harcourt, Nigeria.

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Date: Sept-Dec 2020
From: Port Harcourt Medical Journal(Vol. 14, Issue 3)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Article
Length: 2,514 words
Lexile Measure: 1580L

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Byline: Woroma. Wonodi, Tamunoiyowuna. Okari

Kawasaki disease (KD) is an acute febrile vasculitis of childhood, predominantly affecting medium-sized arteries with a predilection for coronary arteries and commonly occurring in children under the age of 5 years. Early recognition can be challenging; however, delayed diagnosis increases the risk of coronary artery abnormalities and death. We report a case of KD in a 19-month-old child who presented with prolonged fever, conjunctival congestion, skin rash and redness of lips and tongue. He was initially managed as a case of complicated measles, but with worsening symptoms, KD was suspected. Echocardiography revealed a left coronary artery aneurysm. He received two doses of intravenous immunoglobulin G, over a period of 24 h and responded remarkably to treatment. KD is rare in Port Harcourt, Nigeria, and children with prolonged fever and erythematous rash may be mistakenly managed for measles if there is no high level of suspicion amongst clinicians.

Introduction

Kawasaki disease (KD) is an acute self-limiting, febrile illness of childhood accompanied by vasculitis of medium-sized arteries.[1] Although the most common cause of acquired heart disease in developed countries,[2],[3],[4] it is rare in developing countries.[5],[6] Some cases have been reported in Nigeria[7],[8] but none from Rivers State.

The disease presents as complete or incomplete KD. Echocardiography may reveal coronary artery aneurysm (CAA).[1],[2],[3] Making a diagnosis of KD in a developing country can be quite challenging as common febrile illnesses such as measles may have similar symptomatology.[9],[10],[11],[12],[13]

We, therefore, report this case of a 19-month-old male who met the KD diagnostic criteria.

Case Report

A 19-month-old male, OP, presented with a 3-week history of fever, redness of the eyes and mouth of 18 days, rash and excoriation of the skin of 2-week duration, vomiting and passage of loose stools of 5 days. At onset of illness, he was taken to a health facility where a diagnosis of measles and malaria was made, and he received paracetamol, amoxicillin, calamine lotion, Vitamin A, oral rehydration therapy and antimalarial. With the persistence of symptoms, measles complicated by sepsis was suspected, he was admitted and intravenous antibiotics and fluid added to his treatment. With no clinical improvement, the managing medical team asked for a paediatrician to review by the 3rd week of the illness. His pregnancy was normal, and mother received only routine drugs. He received all immunisation including measles and Bacillus Calmette-Guerin (BCG) vaccines in infancy, according to the National Programme on Immunization in Nigeria.

Clinical examinations revealed an obese child (weight of 21 kg and height of 92.5 cm), febrile (temperature 38.7°C), mildly pale with angular cheilitis, bilateral conjunctival injection, non-pitting bilateral pedal and hand oedema [Figure 1] and [Figure 2]. The lips, oral cavity, tongue and tonsils were erythematous. There was generalised desquamation of the skin in sheets [Figure 2],[Figure 3],[Figure 4],[Figure 5], sparing the upper abdomen and trunk. The skin of the perineum was erythematous and weepy. He also had periungual desquamation of the nails and was irritable. The knees were warm, tender and the right knee measured...

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Source Citation   

Gale Document Number: GALE|A656645793