Atypical Kawasaki Disease: Report of Two Cases

非典型性川崎(Kawasaki)病：二病例報告

黃玉成(Yhu-Chering Huang) ； 黃富源(Fu-Yuan Huang) ； 李宏昌(Hong-Chun Lee)

《Acta Paediatrica Sinica》 33卷3期 (1992/06) Pp. 206-211

摘要

本文提出兩例非典型性川崎病病例報告並參考文獻討論此症。病例一是位五個月大的男嬰因持續高燒十天，併有咳嗽、輕微腹瀉來院求診。理學檢查呈肝腫大，實驗室檢查則發現有白血球增多、血小板增多、血沈速率增快及腦脊髓液白血球上升等。在敗血症併腦膜炎的臆斷下，給予抗生素治療。不幸，患兒於住院的第八天發生猝死；解剖發現在左冠狀動脈併有極度栓塞的動脈瘤。病例二是位四個月大的男嬰，因高燒合併頸部淋巴腺腫大持續11天轉來本院；先前在使用抗生素後曾有皮疹發生。實驗室檢查呈血小板增多及血沈速率增快。心臟超音波心圖則發現左、右冠狀動脈分別有直徑5-8mm及4mm的動脈瘤。給予靜脈注射高劑量丙種球蛋白及高劑量的阿斯匹靈口服治療後出院。
因此，在川崎病的特異檢查未發展出來以前，我們建議，當(l)病兒呈現部份川崎病的臨床表徵併有血小板增多時，或／及(2)一歲以下的嬰幼兒持續不明原因的發燒時，應將川崎病納入鑑別診斷，而考慮作心臟超音波心圖的檢查。

並列摘要

Two cases of atypical Kawasaki disease are reported. Case 1 was a five-month-old male infant admitted to this hospital with a 10-day's history of high fever. On examination, he appeared ill-looking and only hepatomegaly was noted. Laboratory studies showed leukocytosis, thrombocytosis, elevated ESR and pleocytosis in CSF. He was treated as sepsis with meningitis. Sudden death occurred on the eighth day of admission, and left coronary artery aneurysm with thrombosis was noted at autopsy. Case 2 was a four-month-old male infant referred to our hospital with fever and cervical lymphadenopathy of 11 day's duration, and unresponsive to antibiotics. Skin rash had developed after oxacillin injection. Echocardiogram, performed on the third day of admission, disclosed a 5-8 mm aneurysm of the left coronary artery and a 4 mm aneurysm of the right coronary artery. Before a specific diagnostic test for Kawasaki disease becomes available, we suggest that a possible diagnosis of Kawasaki disease and echocardiographic evaluation should be considered in case of (1) presence of partial criteria of Kawasaki disease with thrombocytosis; and/or (2) young infants with prolonged unexplained fever.

並列關鍵字

atypical Kawasaki disease ； coronary abnormalities ； thrombocytosis ； echocardiogram