Case Report: Acute Fulminant Cerebral Edema With Perivascular Abnormalities Related to Kawasaki Disease

Introduction: Kawasaki disease (KD) is an acute systemic vasculitis in children, but 0.4% of patients with KD exhibit central nervous system involvement. Acute encephalitis and encephalopathy accompanied with KD have been reported to be mostly self-limiting complications. Case Presentation: A 2-year...

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Published inFrontiers in pediatrics Vol. 9
Main Authors Maeda, Kenichi, Chong, Pin Fee, Akamine, Satoshi, Yamashita, Fumiya, Morooka, Yuya, Mori, Harushi, Lee, Sooyoung, Mizuno, Yumi, Kira, Ryutaro
Format Journal Article
LanguageEnglish
Published Frontiers Media S.A 17.09.2021
Subjects
acute brain swelling
acute encephalitis
acute encephalopathy
acute fulminant cerebral edema
Pediatrics
perivascular lesions
vasogenic edema
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Summary:Introduction: Kawasaki disease (KD) is an acute systemic vasculitis in children, but 0.4% of patients with KD exhibit central nervous system involvement. Acute encephalitis and encephalopathy accompanied with KD have been reported to be mostly self-limiting complications. Case Presentation: A 2-year-old girl developed recurrent vomiting, a cluster of generalized seizures, and decreased consciousness on day 12 after the onset of KD. Magnetic resonance imaging (MRI) T2-weighted images on day 13 showed high signal intensities in bilaterally symmetrical and subcortical white matter and thalamus, and linear radial hyperintensities parallel to the cerebral vessels of the periventricular white matter. Diffuse white matter hyperintensity on the apparent diffusion coefficient map suggested vasogenic edema. Subsequently, lethal cerebral edema rapidly progressed in 8 hrs after the MRI examination. Conclusion: To our knowledge, acute fulminant cerebral edema in patients with KD has not been previously reported. We should be aware of the possibility of severe encephalitis related to KD. Furthermore, diffuse white matter vasogenic edema with perivascular abnormalities on MRI may be an alerm, potentially leading to fatal cerebral edema.
Bibliography:This article was submitted to Pediatric Neurology, a section of the journal Frontiers in Pediatrics
Reviewed by: Ahmed Abdel Razek, Mansoura University, Egypt; Takeshi Matsushige, Yamaguchi University, Japan
Edited by: Hong Ni, Children's Hospital of Soochow University, China
ISSN:2296-2360
2296-2360
DOI:10.3389/fped.2021.732110