Abstract
Kawasaki disease (KD) is a multi-systemic vasculitis of pediatric age group. Early diagnosis and treatment is crucial as coronary artery aneurysms may develop in 20-25% of untreated cases in the 2nd -3rd weeks of the disease. The most common urinary finding in the active period is sterile pyuria; which is believed to be a sign of a more severe systemic inflammation. In this study, a 3.5 year old boy who admitted with high fever was presented. As he had pyuria and elevated acute phase reactants, antibiotic treatment was started with a pre-diagnosis of acute pyelonephritis. Later, with the persistence of fever, detection of a negative urine culture result and emergence of dermal, mucosal and conjunctival changes, incomplete KD was diagnosed. In conclusion, it should be remembered that prolonged fever with sterile pyuria can be the initial findings in KD; before the emergence of typical lesions
References
- Watanabe T, Abe Y, Sato S, et al. Sterile pyuria in patients with Kawasaki disease originates from both the urethra and the kidney. Pediatr Nephrol 2007;22: 987-991.
- Ece A, Güneş A, Tan İ, et al. Kawasaki disease: Evaluation of 13 cases. Dicle Med J 2013;40:95-99.
- Jamieson N, Singh-Grewal D. Kawasaki Disease: A Clinician’s Update. Int J Pediatr 2013;2013:645391.
- Choi JY, Park SY, Choi KH, et al. Clinical characteristics of Kawasaki disease with sterile pyuria. Korean J Pediatr 2013;56:13-18.
- Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004;110:2747-2771.
- Aldemir-Kocabaş B, Karbuz A, Karadeniz C, et al. Another face of Kawasaki disease. Turk J Pediatr 2014;56:392-398.
- Sepahi MA, Miri R, Ahmadi HT. Association of sterile pyuria and coronary artery aneurysm in Kawasaki syndrome. Acta Med Iran 2011;49:606–611.
- Bayram MT, Kır M, Kasap Demir B, ve ark. Akut piyelonefrit kliniği ile başvuran bir Kawasaki olgusu. Turk J Pediatr Dis 2012;6:180-184.
- Watanabe T. Pyuria in patients with Kawasaki disease. World J Clin Pediatr 2015;4:25–29.
- Dallaire F, Dahdah N. New equations and a critical appraisal of coronary artery Z scores in healthy children. J Am Soc Echocardiogr 2011;24:60-74.
- Bonany PJ, Bilkis MD, Gallo G, et al. Acute renal failure in typical Kawasaki disease. Pediatr Nephrol 2002;17:329-331.
- Melish ME. Kawasaki syndrome (the mucocutaneous lymph node syndrome). Pediatr Ann 1982;11:255-268.
- Wu JM, Chiou YY, Hung WP, et al. Urinary cytokines and renal Doppler study in Kawasaki disease. J Pediatr 2010;156:792-797.
- Ristoska-Bojkovska N, Stavric K, Tasic V. Kawasaki disease
- misdiagnosed as acute pyelonephritis. Pediatr Nephrol 2003;18:851-852.
- Wu CY, Hsieh KS, Chiou YH, et al. Prolonged fever and pyuria: a urinary tract infection presentation of incomplete Kawasaki disease. Acta Paediatr 2005;94:375-377.
Abstract
Kawasaki hastalığı çocukluk çağı multisistemik vaskülitidir. Tedavi edilmemiş olan olguların %20-25 inde hastalığın ilk 2-3. haftasında koroner arter anevrizması gelişebileceğinden erken tanı ve tedavi önem taşır. Steril piyüri hastalığın aktif döneminde en sık görülen idrar bulgusu olup, daha ağır sistemik enflamasyon varlığına işaret eder. Bu çalışmada yüksek ateş nedeniyle başvuran, piyüriyle birlikte akut faz belirteçlerinde yükseklik saptanarak akut piyelonefrit ön tanısıyla antibiyotik tedavisi başlanan, izleminde ateşin sebat etmesi, idrar kültüründe üreme olmaması ve cilt, mukoza ve konjunktiva değişiklerinin ortaya çıkmasıyla inkomplet Kawasaki hastalığı (KH) tanısı alan 3,5 yaşında bir erkek olgu sunulmuştur. Bu nedenle KH’da uzamış ateşle birlikte steril piyürinin hastalık için tipik belirtiler henüz ortaya çıkmadan ilk başvuru bulgusu olabileceği de akılda tutulmalıdır.
References
- Watanabe T, Abe Y, Sato S, et al. Sterile pyuria in patients with Kawasaki disease originates from both the urethra and the kidney. Pediatr Nephrol 2007;22: 987-991.
- Ece A, Güneş A, Tan İ, et al. Kawasaki disease: Evaluation of 13 cases. Dicle Med J 2013;40:95-99.
- Jamieson N, Singh-Grewal D. Kawasaki Disease: A Clinician’s Update. Int J Pediatr 2013;2013:645391.
- Choi JY, Park SY, Choi KH, et al. Clinical characteristics of Kawasaki disease with sterile pyuria. Korean J Pediatr 2013;56:13-18.
- Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004;110:2747-2771.
- Aldemir-Kocabaş B, Karbuz A, Karadeniz C, et al. Another face of Kawasaki disease. Turk J Pediatr 2014;56:392-398.
- Sepahi MA, Miri R, Ahmadi HT. Association of sterile pyuria and coronary artery aneurysm in Kawasaki syndrome. Acta Med Iran 2011;49:606–611.
- Bayram MT, Kır M, Kasap Demir B, ve ark. Akut piyelonefrit kliniği ile başvuran bir Kawasaki olgusu. Turk J Pediatr Dis 2012;6:180-184.
- Watanabe T. Pyuria in patients with Kawasaki disease. World J Clin Pediatr 2015;4:25–29.
- Dallaire F, Dahdah N. New equations and a critical appraisal of coronary artery Z scores in healthy children. J Am Soc Echocardiogr 2011;24:60-74.
- Bonany PJ, Bilkis MD, Gallo G, et al. Acute renal failure in typical Kawasaki disease. Pediatr Nephrol 2002;17:329-331.
- Melish ME. Kawasaki syndrome (the mucocutaneous lymph node syndrome). Pediatr Ann 1982;11:255-268.
- Wu JM, Chiou YY, Hung WP, et al. Urinary cytokines and renal Doppler study in Kawasaki disease. J Pediatr 2010;156:792-797.
- Ristoska-Bojkovska N, Stavric K, Tasic V. Kawasaki disease
- misdiagnosed as acute pyelonephritis. Pediatr Nephrol 2003;18:851-852.
- Wu CY, Hsieh KS, Chiou YH, et al. Prolonged fever and pyuria: a urinary tract infection presentation of incomplete Kawasaki disease. Acta Paediatr 2005;94:375-377.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Case Reports |
| Authors | |
| Publication Date | October 24, 2015 |
| Submission Date | October 24, 2015 |
| Published in Issue | Year 2015 Volume: 42 Issue: 3 |