Feng Jiao, Chen Qiang, Yu Miao, Xu Bei
Department of Pediatric, Baoding No. 1 Central Hospital, Great Wall North Street No.320, Baoding, Hebei, 071000, China.
Department of Emergency, Baoding No. 1 Central Hospital, Great Wall North Street No.320, Baoding, Hebei, 071000, China.
BMC Pediatr. 2025 Aug 20;25(1):632. doi: 10.1186/s12887-025-05957-2.
Kawasaki disease (KD) is an acute systemic vasculitis predominantly affecting children under 5 years of age. To prevent the development of cardiac aneurysms and their associated adverse outcomes, such as coronary artery dissection with subsequent bleeding, early recognition and treatment are of utmost importance. The classic early symptoms of KD include fever, conjunctival congestion, cracked lips, and others. However, these symptoms are not exclusive to KD and can also be observed in a variety of infectious diseases. Peeling of the skin on the hands, feet, fingers, and around the anus typically becomes evident around ten days after the onset of the disease or even later. Once complications occur, treatment may be ineffective. Hence, early diagnosis and timely treatment are essential to control disease progression, prevent further exacerbation of complications, and promote rapid lesion recovery.
A 3-year-old boy initially presented solely with sever cough symptoms, followed by fever, which are typical manifestations of a respiratory illness. Additionally, conjunctival hemorrhage developed during the course of the illness. Laboratory tests showed significant elevation in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Despite anti-infective treatment with ceftriaxone, the condition did not improve. The clinical presentation and laboratory findings were consistent with a diagnosis of incomplete Kawasaki disease (IKD). Immediately after treatment with intravenous immunoglobulin (IVIG) and aspirin, the patient's fever and cough symptoms subsided within the next two days. Cardiac ultrasonography at the time of discharge indicated that the coronary artery had healed. At the 1-month and 3-month follow-ups, the patient was in good general health.
It is uncommon for a patient with Kawasaki disease (KD) to initially present with a severe cough as the predominant symptom, especially in the absence of other classic clinical features and with poor response to anti-infective therapy. Therefore, in such cases, clinicians should maintain a high index of suspicion for incomplete Kawasaki disease (IKD) and promptly conduct coronary artery evaluations to avoid delays in diagnosis and treatment.
川崎病（KD）是一种主要影响5岁以下儿童的急性全身性血管炎。为预防心脏动脉瘤的形成及其相关不良后果，如冠状动脉夹层伴随后的出血，早期识别和治疗至关重要。KD的典型早期症状包括发热、结膜充血、嘴唇干裂等。然而，这些症状并非KD所特有，在多种传染病中也可观察到。手脚、手指及肛门周围皮肤脱皮通常在发病后十天左右甚至更晚才会明显出现。一旦出现并发症，治疗可能无效。因此，早期诊断和及时治疗对于控制疾病进展、防止并发症进一步加重以及促进病变快速恢复至关重要。
一名3岁男孩最初仅表现为严重咳嗽症状，随后出现发热，这是呼吸道疾病的典型表现。此外，病程中出现结膜出血。实验室检查显示红细胞沉降率（ESR）和C反应蛋白（CRP）显著升高。尽管使用头孢曲松进行抗感染治疗，但病情并未改善。临床表现和实验室检查结果符合不完全川崎病（IKD）的诊断。在静脉注射免疫球蛋白（IVIG）和阿司匹林治疗后，患者的发热和咳嗽症状在接下来的两天内消退。出院时心脏超声检查表明冠状动脉已愈合。在1个月和3个月的随访中，患者总体健康状况良好。
川崎病（KD）患者最初以严重咳嗽为主要症状并不常见，尤其是在没有其他典型临床特征且对抗感染治疗反应不佳的情况下。因此，在这种情况下，临床医生应高度怀疑不完全川崎病（IKD），并及时进行冠状动脉评估，以避免诊断和治疗延误。
