Abstract: Kawasaki disease(KD) is acute vasculitis in childhood. The authors report the 12-month-old girl with initial presentation of cardiac murmur who was diagnosed incomplete KD.
Case: A 12-month-old girl with history of 3 days fever up to 38°C and upper respiratory symptoms including rhinorrhea visited a pediatric clinic. Cardiac murmur was noticed, then she was referred to Pediatric Cardiology clinic. She had loss of appetite and her growth curve showed severely underweight of 8.4kg(less than 3p) compared to height 78cm(50~75p).
On hospital day 1, laboratory studies revealed a white blood cell (WBC) 9.4(seg73%, Lym23%)x 103/uL, hemoglobin concentration(Hb) of 5.5 g/dL with hematocrit(Hct) 21%, platelet count 426,000/uL. And laboratory results included ESR 2mm/hr, C-reactive protein 0.05mg/L, AST/ALT 31/19 IU/L, Ferritine 13 ng/mL, TIBC 510ug/dL, Transferrin Saturation Index 2.5% and MCV 50.4fL, MCH 13.4pg, MCHC 26.5g/dL. She had grade II-III/VI end-systolic & early diastolic murmur. The echocardiography showed left main coronary artery dilatation and pericaridial effusion.
Based on diagnosis of incomplete Kawasaki disease and iron deficiency anemia, she treated with IVIG(IV gamma globulin), acetylsalicyclic acid, packed RBC transfusion and supplement of oral iron. On hospital day 2, repeat laboratory studies revelaed Hb 6.5 g/dL, and the murmur decreased rapidly. 6 days later Hb was 9.3 g/dL. Pro-BNP was 352 pg/ml on hospital day 1 and repeat studies revealed 978 pg/ml on hospital day 2, 84pg/ml on hospital day 8.
The patient was discharged 8 days after admission(on day 11 of her illness) without fever.
After 1 month of discharge, she had gained weight to 10.5kg and laboratory study results Hb 11.0 g/dL.
And follow-up echorcardiography showed improvement of coronary arteries.
The authors report one child presenting with heart murmur under incomplete Kawasaki disease.