Intensive Care Medicine

, Volume 38, Issue 5, pp 872–878

Kawasaki disease: an unexpected etiology of shock and multiple organ dysfunction syndrome

  • Pauline Gatterre
  • Mehdi Oualha
  • Laurent Dupic
  • Franck Iserin
  • Christine Bodemer
  • Fabrice Lesage
  • Philippe Hubert
Pediatric Original

DOI: 10.1007/s00134-012-2473-8

Cite this article as:
Gatterre, P., Oualha, M., Dupic, L. et al. Intensive Care Med (2012) 38: 872. doi:10.1007/s00134-012-2473-8

Abstract

Objective

Severe forms of Kawasaki disease (KD) associated with shock have recently been reported in which a greater number of coronary artery abnormalities (CAA) were observed. In this study, we analyzed organ involvement not restricted to cardiovascular aspects in severe KD and assessed whether their outcome is different than in common forms.

Design

Retrospective study.

Setting

A 12-bed pediatric intensive care unit (PICU) in a university hospital setting.

Patients

All patients managed in the PICU with a diagnosis of KD from 1 January 2001 to 30 April 2009.

Results

Eleven patients were admitted because of moderate febrile shock without initial KD diagnosis. Median age was 75 months (6–175) with a male:female ratio of 1.4. KD was diagnosed and treated after a delay of 1 day (0–2), for a total of 7 days (5–9) after fever onset. Seven patients (63%) developed CAA after 21 days (6–30) with complete regression within a delay of 120 days (18–240). Nonspecific encephalopathy (n = 6) as well as acute kidney injury (n = 10) were also observed. Multiple organ dysfunction syndrome (MODS) occurred in eight patients. Although predicted mortality according to the PELOD score [21 (10–43)] ranged from 20% to up to 50%, all 11 children survived with no sequelae.

Conclusion

Moderate shock is the main reason for PICU admission in children suffering from KD. These forms can be associated with surprising MODS. Despite the severity of symptoms, all patients survived without any sequelae, hence the need for proper diagnosis and rapid treatment of these unusual severe forms.

Keywords

Kawasaki disease Shock Multiple organ dysfunction syndrome Pediatric intensive care unit 

Supplementary material

134_2012_2473_MOESM1_ESM.doc (26 kb)
Supplementary material 1 (DOC 25 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Pauline Gatterre
    • 1
  • Mehdi Oualha
    • 1
  • Laurent Dupic
    • 1
  • Franck Iserin
    • 2
  • Christine Bodemer
    • 3
  • Fabrice Lesage
    • 1
  • Philippe Hubert
    • 1
  1. 1.Service de Réanimation Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Faculté de MédecineUniversité Paris-DescartesParis Cedex 15France
  2. 2.Service de Cardiologie Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Faculté de MédecineUniversité Paris-DescartesParis Cedex 15France
  3. 3.Service de Dermatologie Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Faculté de MédecineUniversité Paris-DescartesParis Cedex 15France

Personalised recommendations