Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Clinical fetures of kawasaki disease in school-aged children

학동기 아동에서의 가와사끼병의 임상 특징

  • Park, Eun Young (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Kim, Ji Hye (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Kim, Hae Soon (Department of Pediatrics, School of Medicine, Ewha Womans University) ;
  • Shon, Sejung (Department of Pediatrics, School of Medicine, Ewha Womans University)
  • 박은영 (이화여자대학교 의과대학 소아과학교실) ;
  • 김지혜 (이화여자대학교 의과대학 소아과학교실) ;
  • 김혜순 (이화여자대학교 의과대학 소아과학교실) ;
  • 손세정 (이화여자대학교 의과대학 소아과학교실)
  • Received : 2006.09.07
  • Accepted : 2006.09.27
  • Published : 2007.03.15
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Abstract

Purpose : Kawasaki disease (KD) rarely occurs in school-aged children. We clarified the characteristics of KD in this age group to provide tips for a high index of suspicion. Methods : Features of 38 patients with KD who were 7 years of age or older were retrospectively reviewed. Results : The incidence of the KD patients ${\geq}7years$ was 4.9 percent. The ratio of male to female was 2.5:1. Of the 38 patients, nine patients (24.0 percent) were diagnosed with typical KD and 29 patients (76.0 percent) with incomplete KD. In incomplete KD patients, cervical lymphadenopathy (69.0 percent) occurred most frequently, followed by conjunctival injection (62.0 percent) and polymorphous rash (45.0 percent). These patients occasionally presented with other additional symptoms including abdominal pain, headache, vomiting and arthralgia. Incomplete KD was initially diagnosed as cervical lymphadenitis (34.0 percent), viral infection (14.0 percent), scarlet fever (7.0 percent), meningitis (7.0 percent), and Kikuchi disease (7.0 percent). Coronary complications were noted in 15 patients (39.0 percent). Of the 37 patients treated with intravenous immunoglobulin, five (14.0 percent) were resistant to the therapy and all had coronary abnormalities. Conclusion : Most patients with KD ${\geq}7years$ of age have incomplete presentations. They tend to have a higher incidence of initial presentations of unilateral neck mass and coronary artery involvement. In school-aged children, fever and cervical lymphadenitis or suspected neck infection unresponsive to intravenous antibiotics should signal the possibility of KD. A high index of suspicion and prompt treatment is essential in this age group of patients.

목 적 : 학동기 아동에서의 가와사끼병은 드물게 나타나며 대부분 불완전한 양상을 보이므로 진단이 늦어지고 심혈관계 합병증의 발생이 증가한다. 본 연구에서는 이들의 임상 특징을 조사하여 이 연령군에서 가와사끼병의 조기 진단에 도움이 되고자 하였다. 방 법 : 1995년 6월부터 2006년 5월까지 가와사끼병으로 입원하여 치료받은 7세 이상의 소아 38명을 대상으로 임상 특징을 후향적으로 조사하였다. 결 과 : 연구 기간 중 7세 이상의 환아는 4.9%이었고, 남녀 비는 2.5:1이었고, 연령 분포는 7-12세였다. 76%가 불완전형 가와사끼병으로 이 때에는 발열을 제외하고 경부 림프절 비대가 가장 흔히 나타났고(69%), 다음으로 양측성 결막 충혈(62%), 부정형 발진(45%)의 순이었다. 또한 복통, 두통, 구토 및 관절통 등 다른 증상을 동반하는 경우가 있었다. 불완전형 가와사끼병의 초기 진단명은 경부 림프절염이 10명(34%)으로 가장 많았고, 그 외에 바이러스 감염 4명(14%), 성홍열 2명(7%), 뇌수막염 2명(7 %), Kikuchi 병(Kikuchi disease) 2명(7%)의 순이었다. 관상동맥 합병증은 15명(39%)에서 나타났고, 첫번째 IVIG 치료에 반응하지 않은 경우는 5명(14%)이었으며 이들에서 모두 관상동맥 병변이 발생하였다. 결 론 : 학동기 아동의 가와사끼병은 대부분 불완전형으로, 경부 림프절 비대가 흔하게 나타나며 심혈관계 합병증의 발생률이 높고 비특이적인 증상들을 동반하는 경우가 많아 다른 감염성 질환으로 오진되기 쉽다. 따라서, 항생제 치료에 반응하지 않고 발열이 지속될 경우 가와사끼병의 가능성을 항상 염두에 두어야 하며 조기 진단 및 치료를 함으로써 심혈관계 합병증의 위험성을 감소시켜야 한다.

Keywords

References

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