Mucocutaneous lymphonodular syndrome (Kawasaki) in a three-year-old child (the clinical case description)

Background. Kawasaki syndrome (mucocutaneous lymphonodular syndrome) is an acute systemic disease with damage to small and medium arteries and the development of destructive-proliferative vasculitis, which occurs mainly in children under five years of age. Its etiology and pathogenesis are still unclear, but it is believed that the disease is a manifestation of a combination of complex interactions of genetic factors, infections and immunity. Due to the peculiarities of the clinical picture (multiple organ damage and complexity of diagnosis), the disease occupies a special place in the work of a practicing pediatrician.

Objective. The purpose of the work is to present the features of the course of a case of Kawasaki syndrome in a 3-year-old child based on clinical observation.

Materials and methods. Analysis of the medical record of an inpatient f.003/u, clinical and genealogical method, functional research methods (ultrasound of the abdominal organs, lymph nodes, electrocardiography, heart ultrasound), clinical and biochemical analysis of blood and urine. A literature review based on the results of a search of literary sources in the eLIBRARY.RU, PubMed databases. The analysis included literature reviews, scientific articles, monographs, and clinical studies.

Conclusion. The case we presented confirms the need for pediatricians to be alert to children with the following clinical manifestations: fever, conjunctival injection, changes in the mucous membranes (dry, cracked lips; raspberry tongue, hyperemia of the lips and oropharynx), rash (polymorphic – maculopapular, urticarial, scarlet fever-like, or even morbilliform without vesicles or crusts). Kawasaki syndrome can occur under the "mask" of an acute respiratory infection, endocarditis, and a number of rheumatological diseases. Children who have catarrhal (catarrhal symptoms of the mucous membrane of the oropharynx, conjunctivitis), articular, skin syndromes in combination with fever, as well as cervical lymphadenitis, must undergo heart ultrasound.

1. Baranov A. A., Namazova-Baranova L. S., Tatochenko, Basargina E. N., Bakradze M. D., Vishneva E. A., Selimzyanova L. R., Kulichenko T. V., Vashakmadze N. D., Revunenkov G. V., Polyakova A. S., Fedorova N. V. Review of clinical recommendations on Kawasaki disease/syndrome. Pediatricheskaya farmakologiya. 2017; 14 (2): 87-99. DOI: 10.15690/pf.v14i2.1723. (In Russ.)

2. Bakradze M. D., Khokhlova T. A., Polyakova A. S., Tatochenko V. K. Kawasaki syndrome in children: literature review and analysis of 22 own observations. Farmateka. 2015: 11 (304): 45-50. (In Russ.)

3. Watts R. A., Hatemi G., Burns J. C., Mohammad A. J. Global epidemiology of vasculitis. Nat Rev Rheumatol. 2022; 18 (1): 22-34. DOI: 10.1038/s41584-021-00718-8.

4. Matsubara Y., Matsubara D., Ae R., Kosami K., Aoyama Y., Yashiro M., Makino N., Matsubara S., Nakamura Y. Cumulative incidence of Kawasaki disease with cardiac sequelae in Japan. Pediatr Int. 2020; 62 (4): 444-450. DOI: 10.1111/ped.14164.

5. Kim G. B., Park S., Eun L. Y., Han J. W., Lee S. Y., Yoon K. L., Yu J. J., Choi J. W., Lee K. Y. Epidemiology and Clinical Features of Kawasaki Disease in South Korea, 2012-2014. Pediatr Infect Dis J. 2017; 36 (5): 482-485. DOI: 10.1097/INF.0000000000001474.

6. Huang Y. H., Lin K. M., Ho S. C., Yan J. H. Lo M. H., Kuo H. C. Increased Incidence of Kawasaki Disease in Taiwan in Recent Years: A 15 Years Nationwide Population-Based Cohort Study. Front Pediatr. 2019; 7: 121. DOI: 10.3389/fped.2019.00121.

7. Bregel L. V., Subbotin V. M., Soldatova T. A., et al. Epidemiologic features of Kawasaki disease in the Irkutsk region: results of long-term observations. Pediatrics. Pediatriya. Zhurnal im. G. N. Speranskogo. 2011; 90 (5): 49-53. (In Russ.)

8. Watts R. A., Hatemi G., Burns J. C., Mohammad A. J. Global epidemiology of vasculitis. Nat Rev Rheumatol. 2022; 18 (1): 22-34. DOI: 10.1038/s41584-02100718-8.

9. Seki M., Minami T. Kawasaki Disease: Pathology, Risks, and Management. Vasc Health Risk Manag. 2022; 18: 407-416. DOI: 10.2147/VHRM.S291762.

10. McCrindle B. W., Rowley A. H., Newburger J. W., Burns J. C., Bolger A. F., Gewitz M,. Baker A. L., Jackson M. A., Takahashi M., Shah P. B., Kobayashi T., Wu M. H., Saji T. T., Pahl E.; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Epidemiology and Prevention. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation. 2017; 135 (17): e927-e999. DOI: 10.1161/CIR.0000000000000484.

11. Gupta A. Kawasaki Disease and Infections: A Myth or a Reality? Indian J Pediatr. 2022; 89 (8): 747-748. DOI: 10.1007/s12098-022-04284-z.

12. Lin M. C., Lai M. S., Jan S. L., Fu Y. C. Epidemiologic features of Kawasaki disease in acute stages in Taiwan, 1997-2010: effect of different case definitions in claims data analysis. J Chin Med Assoc. 2015; 78 (2): 121-126. DOI: 10.1016/j.jcma.2014.03.009.

13. Kantemirova M. G., Novikova Yu. Yu., Ovsyannikov D. Yu., et al. Pediatric multisystem inflammatory syndrome associated with a novel coronavirus infection (COVID-19): current information and clinical observation. Pediatricheskaia farmakologiia. 2020; 17 (3): 219-229. (In Russ.)

14. Huygen F. J., De Bruijn A. G., De Bruin M. T., Groeneweg J. G., Klein J., Zijlstra F. J. Evidence for local inflammation in complex regional pain syndrome type 1. Mediators Inflamm. 2002; 11 (1): 47-51. DOI: 10.1080/09629350210307.

15. Galeotti C., Bayry J., Kone-Paut I., Kaveri S. V. Kawasaki disease: aetiopathogenesis and therapeutic utility of intravenous immunoglobulin. Autoimmun Rev. 2010; 9 (6): 441-448. DOI: 10.1016/j.autrev.2009.12.004.

16. Takahashi K., Oharaseki T., Yokouchi Y. Update on etio and immunopathogenesis of Kawasaki disease. Curr Opin Rheumatol. 2014; 26 (1): 31-36. DOI: 10.1097/BOR.0000000000000010.

17. Dimitriades V. R., Brown A. G., Gedalia A. Kawasaki disease: pathophysiology, clinical manifestations, and management. Curr Rheumatol Rep. 2014; 16 (6): 423. DOI: 10.1007/s11926-014-0423-x.

18. Verdoni L., Mazza A., Gervasoni A., Martelli L., Ruggeri M., Ciuffreda M., Bonanomi E., D'Antiga L. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020; 395 (10239): 1771-1778. DOI: 10.1016/S01406736(20)31103-X.

19. Mardi P., Esmaeili M., Iravani P., Abdar M. E., Pourrostami K., Qorbani M. Characteristics of Children With Kawasaki Disease-Like Signs in COVID-19 Pandemic: A Systematic Review. Front Pediatr. 2021; 9: 625377. DOI: 10.3389/fped.2021.625377.

20. Yasuhara J., Watanabe K., Takagi H., Sumitomo N., Kuno T. COVID-19 and multisystem inflammatory syndrome in children: A systematic review and meta-analysis. Pediatr Pulmonol. 2021; 56 (5): 837-848. DOI: 10.1002/ppul.25245.

21. Agarwal S., Agrawal D. K. Kawasaki disease: etiopathogenesis and novel treatment strategies. Expert Rev Clin Immunol. 2017; 13 (3): 247-258. DOI: 10.1080/1744666X.2017.1232165.

22. Loomba R. S., Villarreal E., Flores S. COVID-19 and Kawasaki syndrome: should we really be surprised? Cardiol Young. 2020; 30 (7): 1059-1060. DOI: 10.1017/S1047951120001432.

23. Elouardi Y., Rebahi H., Zarrouki Y., Ziadi A., Younous S., Samkaoui M. A. Síndrome inflamatorio multisistémico de tipo Kawasaki asociado a COVID-19 en un adulto [COVID-19 associated Kawasaki-like multisystem inflammatory syndrome in an adult]. Rev Esp Anestesiol Reanim. 2022; 69 (1): 43-47. Spanish. DOI: 10.1016/j.redar.2020.11.013.

24. Ostroukhova I. P., Striga E. V., Rychkova T. I., et al. Clinical experience of diagnostics and treatment of children with Kawasaki syndrome. Orenburgskii meditsinskii vestnik. 2017; 1 (17):33-39. (In Russ.)

25. Lutfullin I. Ya. Kawasaki syndrome: clinical algorithms and the problem of hypodiagnosis of the disease. Vestnik sovremennoi klinicheskoi meditsiny. 2016; 9 (2): 52-60. DOI: 10.20969/VSKM.2016.9(2).52-60. (In Russ.)