Background: Kawasaki disease (KD) is an acute febrile illness characterized by systemic vasculitis. Recurrences of KD (defined as at least three clinical signs of KD in addition to fever ≥ 5 days), presenting ≥ 14 days after the return to baseline from the index episode is reported in approximately 3-4% of all cases in Japan.
Objective: To assess the frequency and determined the risk factors associated with recurrences of KD in patients treated at the Instituto Nacional de Pediatría in Mexico City.
Material and Methods: An observational, comparative, retrospective and case-control study of all patients diagnosed with recurrent KD in our Institution from August 1995 and May 2014 was performed. The clinical presentation, laboratory results, treatment used and coronary artery abnormalities in the recurrent-KD and non-recurrent KD groups were analyzed and compared.
Results: We included 371 patients with KD diagnosed at our institution; we had 19 recurrences of KD (5.1%), 16 patients had one recurrence, 1 patient had 2 recurrences and 1 patient had 3 recurrences of KD. 17 cases or our cases were male (89.4%) with mean age at diagnosis of the first episode of 31.63 ± 36.40 months and with a median of 16 months of the new event after the initial episode (1 to 60 mo.) In bivariate analysis, male gender (p < 0.037), central nervous system manifestations in the acute phase of KD (p < 0.053) and coronary aneurysms at diagnosis (p < 0.05) showed statistical significance. There were no factors associated with recurrence in a multivariate analysis.
Conclusions: This is a very small series of KD with a slightly increased rate of recurrence compared with the rate of recurrences reported in the literature. But to allow an early recognition of a new event, a previous history of KD should be considered to initiate treatment and to achieve better outcomes in the recurrent cases.