1Clinica Pediatrica, Policlinico Universitario, DPMSC, Udine
2Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste
Key words: Kawasaki disease, Atypical presentation, Immunoglobulins
The incidence of Kawasaki disease (KD) varies across countries, and open issues are mainly related to etiology and diagnosis of atypical cases. A multicentric collaborative study was carried out of all cases of KD admitted in paediatric wards of the Friuli Venezia- Giulia Region, Italy, over the period 1990-2001. Out of 58 cases, 82% were younger than 5 years (incidence 9,5/100.000 under 5 years). In 15 cases (26%) the clinical presentation was atypical, lacking one or more of the diagnostic criteria, but diagnosis was made on the basis of the unique combination of clinical and laboratory features. Atypical cases are more likely to occur at younger ages (2.1 versus 3.9 years at onset). ECG changes were found in 25% of cases, but no cases of coronary aneurisms were observed. High-dose immunoglobulins were given soon, after a mean period of 6.5 days from the onset. Since at least 1 in 4 cases of KD has an atypical presentation, diagnostic criteria could be revised to allow earlier diagnosis of atypical cases.
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