J Rheum Dis.  2020 Jan;27(1):68-72. 10.4078/jrd.2020.27.1.68.

Impending Cardiac Tamponade and Hemorrhagic Pleural Effusion as Initial Presentations of Incomplete Kawasaki Disease: A Case Report

• Kim YJ
• Kim KM
• Lee JY
• Yoon JH
• Jeong DC
• Park WY
• Kim GB

• KMID: 2471964
• DOI: http://doi.org/10.4078/jrd.2020.27.1.68

Abstract

Kawasaki disease (KD) is an acute febrile illness that is characterized by systemic inflammation usually involving medium-sized arteries and multiple organs during the acute febrile phase, leading to associated clinical findings. The diagnosis is based on the principal clinical findings including fever, extremity changes, rash, conjunctivitis, oral changes, and cervical lymphadenopathy. However, KD diagnosis is sometimes overlooked or delayed because other systemic organ manifestations may predominate in acute phase of KD. As a cardiovascular manifestation, an acute pericarditis usually shows a small pericardial effusion, but large pericardial effusion showing clinical signs of cardiac tamponade is very rare. Here, we described a case of incomplete KD presenting with impending cardiac tamponade, and recurrent fever and pleural effusion.

Keyword

Cardiac tamponade; Pleural effusion; Mucocutaneous lymph node syndrome

MeSH Terms

Arteries
Cardiac Tamponade*
Conjunctivitis
Diagnosis
Exanthema
Extremities
Fever
Inflammation
Lymphatic Diseases
Mucocutaneous Lymph Node Syndrome*
Pericardial Effusion
Pericarditis
Pleural Effusion*

Figure

• 

  Figure 1 Frontal view of the chest radiograph shows cardiomegaly and pleural effusion at right thorax.

• 

  Figure 2 The echocardiographic apical four-chamber view (A) and parasternal short-axis view (B) show a massive pericardial effusion with impending cardiac tamponade.

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  Figure 3 Clinical course and treatment of this patient. KD: Kawasaki disease, PCD: pigtail catheter drainage, IVIG: intravenous immunoglobulin.

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