Refractory pneumonia and high fever

• Published in: The Lancet (British edition) Vol. 373; no. 9677; p. 1818
• Main Authors: Falcini, Fernanda, Prof, Vitale, Agata, MD, La Torre, Francesco, MD, Conti, Giovanni, MD, Fede, Carmelo, Prof, Calcagno, Giuseppina, Prof
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 23.05.2009; Elsevier; Elsevier Limited
• Subjects: Anti-Inflammatory Agents - therapeutic use; Biological and medical sciences; Blood; Blood tests; Child, Preschool; Conjunctivitis - etiology; Coronary Disease - etiology; Female; Fever; Fever of Unknown Origin - etiology; General aspects; Humans; Immunoglobulins, Intravenous - therapeutic use; Immunologic Factors - therapeutic use; Internal Medicine; Medical diagnosis; Medical sciences; Medical treatment; Methylprednisolone - therapeutic use; Mucocutaneous Lymph Node Syndrome - complications; Mucocutaneous Lymph Node Syndrome - diagnosis; Mucocutaneous Lymph Node Syndrome - drug therapy; Physical examinations; Pleural Effusion - etiology; Pneumonia; Pneumonia - etiology; Thrombocytosis - etiology; Medicine; Refractory; Lung disease; Pneumonia; Treatment resistance; Respiratory disease; Fever
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(09)60694-2

Blood test results showed: erythrocyte sedimentation rate (ESR) 99 mm/h, C-reactive protein (CRP) 278 mg/L, white blood cell count 13?7×109/L (neutrophils 86%), haemoglobin 110 g/L, platelets 31?2×109/L, and total proteins 48 g/L (serum albumin 37%). Echocardiogram showed a pericardial effusion, and dilatation of the right coronary artery (Z score=3?23).1 The constellation of persistent fever, pericarditis, coronary ectasia, pneumonia refractory to conventional therapy, conjunctivitis, high indices of inflammation, thrombocytosis, and low albumin and sodium concentra tions were suggestive of atypical Kawasaki disease.