一个5个月大婴儿的川崎病

Juliana Maciel, Daniel Meireles, M. Magalhães, S. Gonçalves, S. Fernandes, P. Fernandes
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摘要

简介:川崎病是一种病因不明的中小型动脉急性自限性血管炎,是大多数发达国家儿童心脏病的主要原因。如果不及时治疗,它会导致冠状动脉扩张和动脉瘤,使患者面临冠状动脉血栓形成、心肌梗死或猝死的风险。病例报告:一名先前健康的五个月大男孩,有呼吸道症状和发热史,因呼吸道合胞病毒细支气管炎住院。患者持续发热5天,并伴有临床恶化和结膜注射、唇裂、手脚肿胀和四肢多形皮疹的顺序发展。诊断程序显示炎症标志物水平升高,低钠血症,低白蛋白血症,无菌脓尿和无菌性脑膜炎。尽管最初的超声心动图正常,但怀疑是川崎病,男孩在第五天开始静脉注射免疫球蛋白。第7天,超声心动图显示胰脏炎和轻度冠状动脉扩张迹象,开始使用乙酰水杨酸。男孩出院,但8天后超声心动图显示主要和弥漫性冠状动脉扩张在随访咨询,他再次入院开始皮质类固醇治疗。5个月后,男孩表现出正常的心脏变化,没有进一步的并发症。评论:6个月以下的川崎病是罕见的,并且与冠状动脉瘤的高风险相关。重要的是要认识到与该实体相关的临床和实验室标准,并开始早期治疗,避免心脏并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Kawasaki disease in a five-month-old infant
Introduction:  Kawasaki disease, an acute self-limited vasculitis of small and medium arteries of unknown etiology, is the leading cause of heart disease in children in most developed countries. If untreated, it can lead to coronary artery dilatation and aneurysm, placing patients at risk for coronary thrombosis, myocardial infarction, or sudden death. Case Report: A previously healthy five-month-old boy presented with a history of respiratory symptoms and fever, being admitted for respiratory syncytial virus bronchiolitis. He maintained fever for five days associated with progressive clinical worsening and sequential development of conjunctival injection, cracked lips, swelling of hands and feet, and polymorphous rash of the limbs. Diagnostic procedures showed increased levels of inflammatory markers, hyponatremia, hypoalbuminemia, sterile pyuria, and aseptic meningitis. Despite an initial normal echocardiogram, Kawasaki disease was suspected and the boy started intravenous immunoglobulin on the fifth day. On the seventh day, echocardiogram showed signs of pancarditis and mild coronary artery ectasia and acetylsalicylic acid was started. The boy was discharged, but eight days later echocardiogram revealed major and diffuse coronary artery ectasia in a follow-up consultation and he was readmitted to start corticosteroid therapy. After five months, the boy displayed normalization of cardiac changes, without further complications. Comments: Kawasaki disease below six months of age is rare and associated with a high risk of coronary artery aneurysm. It is important to recognize the clinical and laboratory criteria associated with this entity and start early treatment, avoiding cardiac complications.
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