Int. J. Pharm. Sci. Rev. Res., 62(1), May - June 2020; Article No.

16, Pages: 94-96 ISSN 0976 – 044X

Case Report

Kawasaki Disease: A Case Report

Dr. Cheppalli Vani*, P. Salome Satya Vani1, Mubeena shirin2, U. Niharika3

Assistant professor*,1, Pharm.D2,3, Department of Pharmacy Practice,
Pulla Reddy Institute of Pharmacy, Domadugu (V) Gummadidala (M), Telangana, India.
*Corresponding author’s E-mail: [email protected]

Received: 06-03-2020; Revised: 17-04-2020; Accepted: 24-04-2020.

ABSTRACT
Kawasaki disease also called as mucocutaneous lymph node syndrome. It is characterised by an acute febrile illness and acute
multisystem vasculitis that occurs predominantly in infants and young children. The pathological changes in Kawasaki Disease affect
medium-sized, extra-parenchymal muscular arteries and most commonly the coronary arteries. Acute phase of Kawasaki Disease is
characterized with leukocytosis of immature and mature granulocytes, normochromic, normocytic anemia, and elevated proteins.
The aetiology of Kawasaki disease is unknown but commonly described as an exaggerated immune response to environmental or
infectious trigger in developmentally, immunologically and genetically susceptible children. Here is the case of 8year female patient
was admitted in hospital with complaints of low grade fever, headache, macula-papulae rashes over both palms, foot over plantae
surface associated with itching and redness all over upper and lower limbs since 3 days. This patient was diagnosed in early phase
of Kawasaki disease and laboratory investigations were WBC: 15000/cumm, ESR: 46 mm/hr, CRP: 5.5 mg/L and Platelets: 4.97
Lakhs/cumm. The patient was treated by pediatrician with Intravenous immunoglobulin, Paracetamol and Ceftazidime. The
symptoms were subsided after one week of treatment. The patient was discharged with prescription of antihistamines and vitamin
supplements.
Keywords: Kawasaki disease, Mucocutaneous lymph node syndrome, Vasculitis.

INTRODUCTION Third phase- Disease signs and symptoms slowly go away

unless complications develop. It may be long as 8 weeks

K awasaki disease also referred to as Kawasaki

syndrome or mucocutaneous lymph node syndrome
affects children. The acute phase of the condition
commonly lasts 10- 14 days or more. Most children recover
fully. But in some cases, Kawasaki disease can lead to long
before energy level seems normal again3.
Etiology: The exact cause of Kawasaki disease is still
unknown. Researchers speculate that a mixture of genetics
and environmental factors can cause KD. This may be due
term heart complications. The disease is named after Dr. to the fact that cause KD occurs during specific seasons and
Tomisaku Kawasaki, a Japanese paediatrician1. Kawasaki tends to affect children4.
disease is the leading cause of acquired heart disease in
Risk factors: Age: It is more likely between the ages of 1
infants and young children. Kawasaki disease causes
year and 5 years. Gender: boys are more likely than girls
inflammation in the walls of medium sized arteries
to develop it. Genetics: if the parents had Kawasaki
throughout body2. It primarily affects children. The
disease, their offspring may be more likely to have it,
inflammation tends to affect the coronary arteries which
suggesting that it may be linked to an inherited gene.
supply blood to heart muscles. It affects lymph nodes, skin
Environment: In the northern hemisphere, from January
and the mucous membranes inside mouth, nose and
through March, the rate is 40 percent higher than in august
throat.
through October. Some suggest it may be a reaction to
Symptoms of Kawasaki disease appear in three phases. some toxins or medications, but clinical evidence is
First phase- A fever that is often higher than 102.2F (39˚C) lacking5.
and lasts more than 3 days, extremely red eyes
Complications: Patients with Kawasaki disease can
(conjunctivitis) without thick discharge, a rash on main part
develop heart complications such as mild dilation of the
of body (trunk) and in genital area, red dry cracked lips, an
coronary arteries. These abnormalities usually diagnosed
extremely red swollen tongue (strawberry tongue),
in the first two weeks of the illness, are likely to resolve
swollen red skin on palms of hands and soles of feet,
spontaneously within a few weeks or months. Heart
swollen lymph nodes in neck and irritability.
complications include: inflammation of blood vessels
Second phase- Peeling of skin on hands and feet especially (vasculitis), usually the coronary arteries, hat supply blood
the lips, fingers and toes often in large sheets, joint pains, to heart, Inflammation of heart muscle (myocarditis), heart
diarrhoea, vomiting, abdominal pain. valve problems. Inflammation of the coronary arteries can
lead to weakening and bulging of the artery wall
(aneurysm). Aneurysms increase the risk of blood clots

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Int. J. Pharm. Sci. Rev. Res., 62(1), May - June 2020; Article No. 16, Pages: 94-96 ISSN 0976 – 044X

forming and blocking the artery which would lead to a globulin. Plasmapheresis is a procedure where the patient
heart attack or cause life-threatening internal bleeding6,3. plasma is removed from blood and replaced with protein
containing fluids. By taking out portions of the patient
Diagnosis: There is no specific diagnostic test, although
plasma the procedure also removes antibodies and
laboratory and echocardiography findings (ex- elevated
proteins that are felt to be part of the immune reaction
erythrocyte sedimentation rate and C- reactive protein
that is causing inflammation of the disease. Kawasaki
level, hyponatremia, hypoalbuminemia, coronary
disease that is not responding to traditional treatment
aneurysms) may be helpful in evaluating suspected cases
aspirin and gamma immunoglobulin infusions can be
and differentiating Kawasaki disease from other
deadly10.
conditions. Diagnosis largely is a process of ruling out
diseases that cause similar signs and symptoms including: CASE STUDY
scarlet fever which is caused by streptococcal bacteria and
A female patient of age 8 yrs was admitted in hospital with
results in fever, rash, chills and sore throat. Juvenile
complaints of low grade fever since 3 days followed by
rheumatoid arthritis, steven – Johnson syndrome, toxic
headache, macula-papulae rashes associated with itching
shock syndrome, measles. The doctor will do a physical
and redness all over upper and lower limbs as shown in the
examination and other tests include urine tests, blood
figure (1, 2). Her vitals were noted as Temperature was
tests. Testing for substance called B- type natriuretic
99.2F, Blood pressure was 90/60 mm of Hg, Pulse rate was
peptide (BNP) that is released when heart is under stress.
110 per min, Respiratory rate was 22 per min, Spo 2 was
Electrocardiogram and echocardiogram is also done7,4.
98%. Levels of serum acute phase reactants includes
Pathophysiology: In the earliest stages of disease the erythrocyte sedimentation rate (46 mm/h) and C-reactive
endothelial cells and the vascular media become protein (5.5 mg/dL) were high; no bacterial growth was
oedematous, but the internal elastic lamina remains intact. detected in any of her culture. Her white blood cell count
Then approximately 7-9 days after onset of fever, an influx was 15,000/cumm; platelet count was 4.97 lakhs/cumm
of neutrophils occurs which is quickly followed by a and the liver function tests were noted within the normal
proliferation of CD8+ (cytotoxic lymphocyte and ranges. Her echocardiograph and ultrasonograph
immunoglobulin A- producing plasma cells. The impression was normal and no significant abnormalities
inflammatory cells secrete various cytokines (tumour were detected.
necrosis factor, monocyte chemotactic and activating
factor), interleukins (IL-1, IL-4, IL-6) and matrix
metalloproteinase’s (MMP3 and MMP9) and target
endothelial cells that lead to fragmentation of internal
elastic lamina and vascular damage8. In severely affected
vessels, the media develops inflammation with necrosis of
smooth muscle cells. The internal and external elastic
laminae can split leading to aneurysms.
Prevention: Kawasaki disease cannot be prevented, but it
can be managed. Certain foods may help promote healthy
blood vessels- a diet rich in nitrates may help promote a
healthy cardiovascular system. Commonly found in
vegetables, nitrate turns into nitric oxide (NO) when
digested, helping support normal endothelial function and
protecting mitochondria. The best way to increase the
production of nitric oxide in body is to consume leafy
greens such as- basil, cabbage, spinach and broccoli.
Exercise can also produce nitric oxide in body9.
Treatment: Children affected by Kawasaki disease are
hospitalised. Kawasaki disease is treated with high doses
of aspirin (salicylic acid) to reduce inflammation and to
mildly thin the blood to prevent blood clot formation. Also
given with gamma immunoglobulin administered through
vein (IVIG) together with fluids. This treatment has been
shown to decrease the chance of developing coronary
aneurysms in the coronary arteries, especially when used
early in the illness. Some corticosteroids medications are
given. Persisting joint pains are treated with anti- Figure (1, 2): Maculopapular rashes over hands and plantar
inflammatory drugs such as ibuprofen or naproxen. Plasma surface of foot
exchange (plasmapheresis) has been reported as effective
in patients who were not responding to aspirin and gamma
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Int. J. Pharm. Sci. Rev. Res., 62(1), May - June 2020; Article No. 16, Pages: 94-96 ISSN 0976 – 044X

The child was treatment with intravenous immunoglobulin treatment with IVIG on or before 5 days of fever resulted
(IVIG) 2g/kg as a single infusion decreases the risk of in better coronary outcomes and decreased the total
developing coronary artery abnormalities when given early length of time of clinical symptoms.
in illness, Injection Paracetamol 360mg IV TID was given to
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Source of Support: Nil, Conflict of Interest: None.

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