Incomplete Kawasaki Disease in a 5-Month-Old Girl Associated with Cerebrospinal Fluid Pleocytosis and Epidural Fluid Collection

Jung-Ok Kim; Hyeon Ju Lee; Kyoung Hee Han

doi:10.14776/piv.2015.22.1.40

Journal List > Pediatr Infect Vaccine > v.22(1) > 1095998

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Lee, and Han: Incomplete Kawasaki Disease in a 5-Month-Old Girl Associated with Cerebrospinal Fluid Pleocytosis and Epidural Fluid Collection

Original Article

Pediatr Infect Vaccine 2015;22(1):40-44.

Published online: 21 January 2015

DOI: https://doi.org/10.14776/piv.2015.22.1.40

Incomplete Kawasaki Disease in a 5-Month-Old Girl Associated with Cerebrospinal Fluid Pleocytosis and Epidural Fluid Collection

Jung-Ok Kim, M.D.^∗, Hyeon Ju Lee^†, Kyoung Hee Han, M.D.^∗,^‡,

^∗Department of Pediatrics∗, Jeju National University Hospital, Jeju, Korea

^†Jeju National University School of Medicine∗, Jeju, Korea

^‡Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea

Kyoung Hee Han, MD. Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea Tel: +82-64-754-8134, Fax: +82-64-754-8134 E-mail: hansyang78@gmail.com

Received 14 October 201425 October 2014 Accepted 26 October 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cases of incomplete Kawasaki disease (KD), wherein the patient does not fulfill the full diagnostic criteria for KD, are often detected in infants younger than 6 months of age. The clinical manifestations in infants with incomplete KD may resemble other infectious diseases, including meningitis. For this reason, clinicians may have difficulty differentiating incomplete KD from other infectious diseases in this population. Various neurological features are associated with KD, including aseptic meningitis, subdural effusion, facial nerve palsy, cerebral infarction, encephalopathy, and reversible corpus callosum splenial lesions on magnetic resonance imaging. We report a case of a 5-month-old girl with incomplete KD, associated with cerebrospinal fluid pleocytosis and an epidural fluid collection. Echocardiography indicated dilatation of the main coronary arteries. The girl made a complete recovery, with resolution of both the epidural fluid collection and coronary artery aneurysms. In this case, the child is well, and showed normal developmental milestones at the 7-month follow-up.

Keywords: Kawasaki disease, Infant, Cerebrospinal fluid, Pleocytosis, Epidural abscess

REFERENCES

1. Burns IC, Glodé MP. Kawasaki syndrome. Lancet. 2004; 364:533–44.

2. Rowley AH, Gonzalez-Crussi F, Gidding SS, Duffy CE, Shulman ST. Incomplete Kawasaki disease with coronary artery involvement. I Pediatr. 1987; 110:409–13.

3. Yeom IS, Woo HO, Park IS, Park ES, 860 IH, Youn HS. Kawasaki disease in infants. Korean I Pediatr. 2013; 56:377–232.

4. Cabral M, Correia P, Brito M], Conde M, Carreiro H. Kawasaki disease in a young infant: diagnostic challenges. Acta Reumatol Port. 2011; 36:304–8.

5. Fujiwara S, Yamano T, Hattori M, Fujiseki Y, Shimada M. Asymptomatic cerebral infarction in Kawasaki disease. Pediatr Neurol. 1992; 8:235–6.

6. Tabarki B, Mahdhaoui A, Selmi H, Yacoub M, Essoussi AS. Kawasaki disease with predominant central nervous system involvement. Pediatr Neurol. 2001; 25:239–41.

7. Takanashi I, Shirai K, Sugawara Y, Okamoto Y, Obonai T, Terada H. Kawasaki disease complicated by mild encephalopathy with a reversible splenial lesion (MERS). J Neurol Sci. 2012; 315:167–9.

8. Bailie NM, Hensey 0}, Ryan S, Allcut D, King MD. Bilateral subdural collections-an unusual feature ofpossible Kawasaki disease. Eur I Paediatr Neurol. 2001; 5:79–81.

9. Limbach HG, Lindinger A. Kawasaki syndrome in infants in the first 6 months of life. Klin Padiatr. 1991; 203:133–6.

10. Chang FY, Hwang B, Chen S], Lee PC, Meng CC, Lu IH. Characteristics of Kawasaki disease in infants younger than six months of age. Pediatr Infect Dis I. 2006; 25:241–4.

11. Yeom IS, Park IS, Seo IH, Park ES, Lim IY, Park CH, et al. Initial characteristics of Kawasaki disease With cerebrospinal ﬂuid pleocytosis in febrile infants. Pediatr Neurol. 2012; 47:259–62.

12. Dengler LD, Capparelli EV, Bastian IF, Bradley D], Glode MP, Santa S, et al. Cerebrospinal ﬂuid profile in patients with acute Kawasaki disease. Pediatr Infect Dis I. 1998; 17:478–81.

13. Terasawa K, Ichinose E, Matsuishi T, Kato H. Neurological complications in Kawasaki disease. Brain Dev. 1983. 5z371–4.

14. Takagi K, Umezawa T, Saji T, Morooka K, Matsuo N. Meningoencephalitis in Kawasaki disease. No To Hattatsu. 1990; 22:429–35.

15. Aoki N. Subdural effusion in the acute stage of Kawasaki disease (Mucocutaneous lymph node syndrome). Surg Neurol. 1988; 29:216–7.

Fig. 1.

Magnetic resonance imaging of the brain shows the epidural fluid collection with pachymeningeal thickening on the left frontoparietal lobe on hospital day 3 (A), and on hospital day 16 (B). A and B are axial T1-weighted post-contrast images.

TOOLS

Similar articles