The Clinical Characteristics of Kawasaki Disease Patients With Sterile Pyuria.

Background: Sterile pyuria is a common manifestation of Kawasaki disease (KD). We investigated the characteristics of KD patients with sterile pyuria.

Methods: This retrospective study included 345 KD patients who had not received antimicrobial therapy before the diagnosis. These patients were divided into 2 groups based on the presence or absence of sterile pyuria, and the clinical characteristics were compared between the 2 groups.

Results: Of the 345 patients, 151 (43.8%) had sterile pyuria. The peripheral neutrophil counts and serum levels of aspartate aminotransferase and C-reactive protein were significantly higher in KD patients with sterile pyuria than in those without sterile pyuria (P < 0.001, P = 0.003, P < 0.001, respectively). The serum sodium levels were significantly lower in the patients with sterile pyuria (P < 0.001). The proportion of KD patients that were resistant to initial high-dose intravenous immunoglobulin (IVIG) therapy was significantly higher in the patients with sterile pyuria (26.5%) than in those without sterile pyuria (10.8%) (P < 0.001). There was no significant difference in the incidence of coronary artery abnormalities between the 2 groups. In the prediction of the patients who were resistant to initial IVIG therapy, the sensitivity of positivity for sterile pyuria (66%) was superior to that of the Gunma score (52%).

Conclusion: KD patients with sterile pyuria are likely to be resistant to initial IVIG therapy. Performing examinations of sterile pyuria may be useful to complement the scoring systems in order to predict the patients who may be resistant to initial IVIG therapy.