Elqadiry R, Louachama O, Rada N, Draiss G, Bouskraoui M
Pediatric A Department, Mother-Child Pole, Mohammed VI University Hospital, Marrakesh, Morocco.
Case Rep Pediatr. 2019 Mar 5;2019:3904932. doi: 10.1155/2019/3904932. eCollection 2019.
While the diagnosis of typical form of Kawasaki disease (KD) is obvious, this multifaceted disease continues to surprise us. We report the case of a recurrent Kawasaki disease in an infant.
At the age of 13 months, the infant was diagnosed with complete Kawasaki disease; he presented with prolonged fever, bilateral conjunctivitis, enanthem, exanthema, edema of the lower limb, peeling, and biological inflammatory syndrome. He was treated with intravenous immunoglobulin (IVIG) associated with a high dose of aspirin and then an antiplatelet dose with a good clinical-biological evolution. The echocardiography was normal. Seven months later, the patient was again admitted, in a similar picture: a prolonged fever evolving for 7 days, bilateral conjunctivitis, enanthem, cervical adenopathy of 1.5 cm/1 cm, scarlatiniform erythema, pruriginous of the trunk and limb, and peeling of the toes, with indurated edema of the hands and feet. The rest of the examination was normal except the irritability. The diagnosis of recurrent KD was made according the five criteria of the American Heart Association. The echocardiography was normal again. The infant received IVIG with good outcome.
Despite its rarity, the possibility of recurrence of KD should be known by clinicians, so as not to delay the specific management of vasculitis whose stakes in terms of prevention of coronary artery lesions are well known. Our case confirms the possibility of this recurrence.
虽然典型形式的川崎病（KD）诊断明确，但这种多方面的疾病仍不断给我们带来惊喜。我们报告一例婴儿复发性川崎病的病例。
该婴儿13个月大时被诊断为完全性川崎病；表现为持续发热、双侧结膜炎、黏膜疹、皮疹、下肢水肿、脱皮及生物学炎症综合征。给予静脉注射免疫球蛋白（IVIG）联合高剂量阿司匹林治疗，随后给予抗血小板剂量治疗，临床生物学指标呈良好演变。超声心动图正常。7个月后，患者再次入院，症状相似：持续发热7天，双侧结膜炎、黏膜疹、1.5厘米/1厘米的颈部淋巴结肿大、猩红热样皮疹、躯干和四肢瘙痒、脚趾脱皮，伴有手足硬结性水肿。除烦躁外，其余检查均正常。根据美国心脏协会的五项标准诊断为复发性KD。超声心动图再次正常。婴儿接受IVIG治疗，效果良好。
尽管KD复发罕见，但临床医生应了解其复发的可能性，以免延误对血管炎的特异性治疗，其在预防冠状动脉病变方面的重要性是众所周知的。我们的病例证实了这种复发的可能性。
