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Journal of Tropical Pediatrics Advance Access originally published online on September 27, 2005
Journal of Tropical Pediatrics 2006 52(4):299-301; doi:10.1093/tropej/fmh076
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© The Author [2005]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Case Report

Kawasaki Disease Presenting with Hemorrhagic Pleural Effusion

Susan D'Souzaa, Raju P. Khubchandania and Avinash K. Shettyb

a Department of Pediatrics, Jaslok Hospital and Research Center, Mumbai, India
b Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA

Correspondence: Avinash K. Shetty, Wake Forest University School of Medicine, Department of Pediatrics, Medical Center Blvd, Winston-Salem, NC 27157, USA. E-mail <avishetty{at}pol.net>.

Hemorrhagic pleural effusion associated with Kawasaki disease (KD) is very rare and has not been reported in the medical literature. We describe a 5-year-old male with incomplete (atypical) KD who presented with fever and severe respiratory distress due to bilateral pleural effusions. Other features included unilateral cervical lymphadenopathy, swelling of the hands and feet followed by periungual desquamation, elevated erythrocyte sedimentation rate, thrombocytosis and sterile pyuria. Pleural fluid analysis revealed a hemorrhagic exudative effusion. Therapy with high-dose i.v. immunoglobulin resulted in dramatic clinical improvement and resolution of pleural effusion. An echocardiogram obtained at presentation and at 6 weeks of illness was normal. Pediatricians should be aware that hemorrhagic pleural effusion can be a presenting manifestation of KD.


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