Clinical case of Kavasaki syndrome

Abstract

Kawasaki syndrome is rare in Europe. This relatively «young» disease was first described by Japanese pediatrician Tomisaku Kawasaki in 1967. The causes of the disease are not clear. Most scientists tend to believe that the disease is triggered by existing foci of infection of viral or bacterial origin in the body, causing inflammation and damage to blood and lymphatic vessels. Kawasaki syndrome is a non­contagious disease, but cases of recurrence have been described.Patients with a high temperature, in the range of 38—40 °C, develop polymorphic rashes: roseola, erythema, urticaria, papules that can mimic measles or scarlet fever. Children are tearful, irritable, often wake up, suffer from diarrhea, abdominal pain. The rash affects the extremities and torso. The lower and upper extremities are swollen; especially pronounced swelling is on the palms, soles and fingers. After 1,5—2 weeks there is a lamellar peeling of the fingertips and toes. The interphalangeal joints are swollen, active movements in children’s joints cause pain and crying as a result. The mucous membranes of the oral cavity are hyperemic, the tongue is deep red (crimson), cheilitis is also diagnosed. There are three phases of the disease: acute — within 2 weeks since the onset, subacute — from 2 to 4 weeks, the recovery phase — from 1 to 3 months. In most patients, the cervical lymph nodes are affected, often one node is palpated ranging in size from 1 to 1.5 cm in diameter. There are no specific laboratory tests to diagnose the syndrome.Considering the sporadic nature and complexity of the diagnosis, we present a clinical case of Kawasaki syndrome in a 3.5­year­old boy. The probable cause of the disease was a combination of chickenpox virus and COVID­19. The variety of symptoms of the syndrome led to diagnostic errors and, accordingly, influenced the tactics of treatment of the primary care physician. Clinical manifestations, complications, route of the patient, complex treatment and rehabilitation are described.In our report, we have focused the attention of pediatricians, family physicians and dermatologists on the fact that Kawasaki syndrome is not a rare disease during the pandemic, and the combination of COVID­19 with other viral and microbial infections led to a multifold increase in the likelihood of serious complications. Timely diagnosis and rational therapy are the prevention of diagnostic errors and complications.