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病例报告:3个月以下婴儿川崎病诊断中的挑战:病例系列报告

Case Report: Challenges in diagnosing Kawasaki disease in children under 3 months of age: a case series report.

作者信息

Phi Duc Long, Nguyen Thi Hoai, Duong Khanh Linh, Nguyen Le Cam Anh, Nguyen Duy Cuong, Hoang Van Thuan

机构信息

Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam.

Thai Binh Pediatric Hospital, Thai Binh, Vietnam.

出版信息

Front Pediatr. 2025 Jul 8;13:1490921. doi: 10.3389/fped.2025.1490921. eCollection 2025.

DOI:10.3389/fped.2025.1490921
PMID:40697501
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12279692/
Abstract

Infants younger than 3 months old often present with incomplete Kawasaki Disease (KD), where not all the classical features are present. This makes the diagnosis challenging, as KD may be easily confused with other common pediatric conditions, such as viral infections, bacterial sepsis, or toxic shock syndrome. Moreover, the risk of developing coronary artery abnormalities is reportedly higher in younger infants, making timely diagnosis and treatment critical. Here we reported three cases of KD in infants under three months, each illustrating the challenges in diagnosis due to the absence of typical KD symptoms such as rash, conjunctivitis, and oral mucosal changes. Echocardiography played a pivotal role in identifying coronary artery abnormalities, leading to the diagnosis of incomplete KD in all cases. Clinicians should maintain a high index of suspicion for KD in any febrile infant, particularly when inflammatory markers are elevated. Early recognition and treatment are vital to prevent severe cardiovascular complications.

摘要

3个月以下的婴儿常表现为不完全川崎病(KD),即并非所有典型特征都出现。这使得诊断具有挑战性,因为KD可能很容易与其他常见的儿科疾病混淆,如病毒感染、细菌性败血症或中毒性休克综合征。此外,据报道,小婴儿发生冠状动脉异常的风险更高,因此及时诊断和治疗至关重要。在此,我们报告了3例3个月以下婴儿的KD病例,每例都说明了由于缺乏皮疹、结膜炎和口腔黏膜变化等典型KD症状而导致的诊断挑战。超声心动图在识别冠状动脉异常方面发挥了关键作用,所有病例均据此诊断为不完全KD。临床医生应对任何发热婴儿保持高度的KD怀疑指数,尤其是当炎症标志物升高时。早期识别和治疗对于预防严重心血管并发症至关重要。

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本文引用的文献

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Update on Diagnosis and Management of Kawasaki Disease: A Scientific Statement From the American Heart Association.川崎病诊断与管理的最新进展:美国心脏协会的科学声明
Circulation. 2024 Dec 3;150(23):e481-e500. doi: 10.1161/CIR.0000000000001295. Epub 2024 Nov 13.
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Guideline for the diagnosis and treatment of incomplete Kawasaki disease in children in China.中国儿童不完全川崎病诊断与治疗指南。
BMC Pediatr. 2024 Jul 26;24(1):477. doi: 10.1186/s12887-024-04961-2.
3
Diagnosis, Progress, and Treatment Update of Kawasaki Disease.
川崎病的诊断、进展和治疗更新。
Int J Mol Sci. 2023 Sep 11;24(18):13948. doi: 10.3390/ijms241813948.
4
Very early onset of coronary artery aneurysm in a 3-month infant with Kawasaki disease: a case report and literature review.3 月龄婴儿川崎病并发冠状动脉瘤:病例报告及文献复习
Ital J Pediatr. 2023 Jun 4;49(1):60. doi: 10.1186/s13052-023-01478-9.
5
Risk factors and coronary artery outcomes of coronary artery aneurysms differing in size and emergence time in children with Kawasaki disease.川崎病患儿不同大小和出现时间的冠状动脉瘤的危险因素及冠状动脉结局
Front Cardiovasc Med. 2022 Sep 9;9:969495. doi: 10.3389/fcvm.2022.969495. eCollection 2022.
6
Effect of Early Intravenous Immunoglobulin Therapy in Kawasaki Disease: A Systematic Review and Meta-Analysis.早期静脉注射免疫球蛋白治疗川崎病的效果:一项系统评价与荟萃分析
Front Pediatr. 2020 Nov 20;8:593435. doi: 10.3389/fped.2020.593435. eCollection 2020.
7
Value of serial echocardiography in diagnosing Kawasaki's disease.系列超声心动图在诊断川崎病中的价值。
Eur J Pediatr. 2021 Feb;180(2):387-395. doi: 10.1007/s00431-020-03752-y. Epub 2020 Sep 21.
8
Characteristics and Indications of Kawasaki Disease Among Infants Under 6 Months.6个月以下婴儿川崎病的特征与指征
Front Pediatr. 2020 Aug 14;8:470. doi: 10.3389/fped.2020.00470. eCollection 2020.
9
Kawasaki Disease in Infants in the First 3 Months of Age in a Mexican Population: A Cautionary Tale.墨西哥人群中3个月龄以内婴儿的川崎病:一则警示故事
Front Pediatr. 2020 Jul 21;8:397. doi: 10.3389/fped.2020.00397. eCollection 2020.
10
Kawasaki disease in infants less than one year of age: an Italian cohort from a single center.一岁以下婴儿川崎病:单中心意大利队列研究。
BMC Pediatr. 2019 Sep 7;19(1):321. doi: 10.1186/s12887-019-1695-0.