PMID- 29888440
OWN - NLM
STAT- MEDLINE
DCOM- 20181011
LR  - 20220408
IS  - 1442-200X (Electronic)
IS  - 1328-8067 (Linking)
VI  - 60
IP  - 9
DP  - 2018 Sep
TI  - Kawasaki disease shock syndrome: Unique and severe subtype of Kawasaki disease.
PG  - 781-790
LID - 10.1111/ped.13614 [doi]
AB  - BACKGROUND: Kawasaki disease shock syndrome (KDSS) is an uncommon presentation of 
      Kawasaki disease (KD). KDSS has been associated with more severe markers of 
      inflammation, coronary abnormalities and i.v. immunoglobulin (IVIG) resistance. 
      METHODS: A retrospective, descriptive study of children with KDSS in two 
      hospitals was performed. Relevant articles about KD and shock were collected, and 
      demographic data, clinical presentation, laboratory variables, echocardiogram 
      findings, treatment and special features were analyzed when available. Twelve 
      patients diagnosed with KDSS were retrospectively reviewed from two centers in 
      Mexico, along with 91 additional cases from the literature. RESULTS: Seventy-two 
      patients presented with complete KD (69.9%), and 30.1% (31/103) had unusual KD 
      manifestations. The most frequent diagnosis at the time of admission was toxic 
      shock syndrome (TSS; n = 20). Sixteen of the 20 had coronary artery 
      abnormalities. Overall, abnormalities in the coronary arteries were documented in 
      65% of the patients. The mortality rate was 6.8%. CONCLUSION: The presence of 
      coronary aneurysms was significantly and positively correlated with male gender, 
      IVIG resistance, inotrope treatment, cardiac failure, abdominal pain and 
      neurological symptoms. IVIG-resistant patients had higher neutrophil : lymphocyte 
      ratio. Abdominal symptoms, hypoalbuminemia and elevated C-reactive protein were 
      present in almost all of the patients. Multisystem involvement with atypical 
      presentation in KDSS is frequent. An important differential diagnosis is TSS. 
      Mechanical ventilation, gastrointestinal and neurological symptoms were 
      associated with IVIG resistance and the presence of coronary aneurysms. The first 
      line of treatment includes IVIG and pulse corticosteroids; in severe cases, 
      infliximab, anakinra, cyclosporine or plasmapheresis are alternative treatment 
      options.
CI  - (c) 2018 Japan Pediatric Society.
FAU - Gamez-Gonzalez, Luisa Berenise
AU  - Gamez-Gonzalez LB
AD  - Allergy and Immunology Department, Children's Hospital, Chihuahua City, Mexico.
FAU - Moribe-Quintero, Isabel
AU  - Moribe-Quintero I
AD  - Clinical Immunology Department, National Institute of Pediatrics, Medica Sur 
      Hospital, Mexico City, Mexico.
FAU - Cisneros-Castolo, Martin
AU  - Cisneros-Castolo M
AD  - Research Methodology Department, Children's Hospital, Chihuahua City, Mexico.
FAU - Varela-Ortiz, Javier
AU  - Varela-Ortiz J
AD  - Pediatric Intensive Care Unit, Medica Sur Hospital, Mexico City, Mexico.
FAU - Munoz-Ramirez, Mireya
AU  - Munoz-Ramirez M
AD  - Intensive Care Unit, National Institute of Pediatrics, Medica Sur Hospital, 
      Mexico City, Mexico.
FAU - Garrido-Garcia, Martin
AU  - Garrido-Garcia M
AD  - Cardiology Department, National Institute of Pediatrics, Medica Sur Hospital, 
      Mexico City, Mexico.
FAU - Yamazaki-Nakashimada, Marco
AU  - Yamazaki-Nakashimada M
AUID- ORCID: 0000-0002-7609-3923
AD  - Clinical Immunology Department, National Institute of Pediatrics, Medica Sur 
      Hospital, Mexico City, Mexico.
LA  - eng
PT  - Journal Article
PL  - Australia
TA  - Pediatr Int
JT  - Pediatrics international : official journal of the Japan Pediatric Society
JID - 100886002
RN  - 0 (Biomarkers)
RN  - 0 (Glucocorticoids)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Adolescent
MH  - Biomarkers/blood
MH  - Child
MH  - Child, Preschool
MH  - Diagnosis, Differential
MH  - Female
MH  - Glucocorticoids/therapeutic use
MH  - Humans
MH  - Immunoglobulins, Intravenous/therapeutic use
MH  - Immunosuppressive Agents/therapeutic use
MH  - Infant
MH  - Male
MH  - Mucocutaneous Lymph Node Syndrome/*complications/mortality/therapy
MH  - Retrospective Studies
MH  - Shock/diagnosis/epidemiology/*etiology
MH  - Survival Rate
OTO - NOTNLM
OT  - Kawasaki disease
OT  - Kawasaki disease shock syndrome
OT  - atypical Kawasaki disease
OT  - shock
OT  - toxic shock syndrome
EDAT- 2018/06/12 06:00
MHDA- 2018/10/12 06:00
CRDT- 2018/06/12 06:00
PHST- 2017/04/04 00:00 [received]
PHST- 2018/01/20 00:00 [revised]
PHST- 2018/06/07 00:00 [accepted]
PHST- 2018/06/12 06:00 [pubmed]
PHST- 2018/10/12 06:00 [medline]
PHST- 2018/06/12 06:00 [entrez]
AID - 10.1111/ped.13614 [doi]
PST - ppublish
SO  - Pediatr Int. 2018 Sep;60(9):781-790. doi: 10.1111/ped.13614.