Kawasaki disease (KD) is a medium vessel vasculitis of childhood. Clinical presentation in infancy is often characterized by paucity of symptoms. We report our experience of managing 15 children with KD aged 6 months and below at the Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India. To the best of our knowledge there are no data on this aspect of KD from any developing country.
Objective: To describe the clinical and laboratory profile of children with KD aged 6 months and below in our cohort
Methods: Records of Pediatric Rheumatology Clinic from 1994 - 2014 were analyzed. Fifteen of the 415 children with KD, diagnosed on the basis of American Heart Association criteria, were aged 6 months and below. Fourteen children were given intravenous immunoglobulin and 3 also received infliximab.
Results: Incomplete KD was present in 13 children (87%). Mucosal changes were present in 11 (73%); extremity changes in 10 (66%); rash in 9 (60%); conjunctival injection in 8 (53%) and lymphadenopathy in 3 (20%) children. Irritability at presentation was noted in 13 (87%); 4 (26%) had respiratory symptoms and 2 (13%) children had BCG scar reactivation. Eleven patients were diagnosed beyond day 10 of illness. Of 12 patients, in whom C-reactive protein was estimated, 11 had raised levels. Thrombocytopenia was seen in 3 patients - one of these developed scrotal gangrene. Coronary artery abnormalities were present in 5 (33%) patients. Two children died from disease related complications - one of these had giant coronary artery aneurysm.
Conclusions: Incomplete forms of KD are commonly seen in children below 6 months of age. This may result in delayed diagnosis.