Introduction: Early diagnosis and treatment of KAWASAKI DISEASE as the most common cause of acquired heart DISEASE in childhood, may significantly improve the prognosis. Diagnosing infantile KAWASAKI (younger than a year) is difficult because of obscure symptoms; at the same time they are at the higher risk of coronary abnormalities.Case Presentation: We report three infants with prolonged (more than 5 days) fever and peripheral gangrene without any other clinical manifestations of KAWASAKI DISEASE. KAWASAKI was diagnosed due to dilation of coronary artery and other aortic branches, thrombocytosis, and rising of ESR and CRP. All patients were treated with high dose aspirin, IVIG and pulse therapy with methylprednisolone. Additionally, cytotoxic drugs or infliximab were used for two of them because of severe aneurysms in the aortic branches. All 3 patients received aspirin with anti-platelet aggregation dose and 2 patients heparin as an anti-coagulant agent for longtime. After adequate treatment, peripheral gangrene, arterial dilations and aneurysms improved, but during 12 months follow-up coronary aneurysms did not improve completely.Conclusions: Peripheral gangrene must be regarded as an important sign of infantile KAWASAKI DISEASE early treatment of which can prevent severe permanent coronary involvements and sequels.

Objectives: The aim of this study was to report the prevalence, clinical course, and sequela of arthritis in KAWASAKI DISEASE (KD), and to establish its relationship to coronary outcomes. Methods: We retrospectively reviewed the records of 524 patients between March 2006 and February 2016. Results: The overall prevalence of arthritis was 17. 6 % (n = 92/524) and among them, 21 cases (22. 8%) had late-onset arthritis and they were older (32. 7 12. 1 vs. 62. 5 23. 8 months), had longer fever duration (5. 8 1. 94 vs. 7. 11 2. 51 days), more frequent swelling or redness of extremities (35. 2 vs. 71. 5%), higher neutrophil counts (58. 69 13. 84 vs. 72. 16 16. 43%), and higher prohormone brain-type natriuretic peptide levels (ProBNP, 1343. 80 1080. 44 vs. 3754. 42 4272. 71 pg/mL) than patients with early onset arthritis. Coronary artery changes were not different and no patients complained of chronic arthritic changes, regardless of arthritis type. Conclusions: Although late-onset arthritis was found in KD patients who were older with longer fever duration, more frequent swelling or redness of extremities, higher neutrophil counts, and higher ProBNP levels than early-onset arthritis patients, there was no statistical significance between arthritis onset type and coronary artery changes, and outcomes were excellent with no chronic arthritis change.

KAWASAKI DISEASE is an acute multiorgan vasculitis occurs mostly in children between six months and five years of age. The etiology of the DISEASE is unknown, but superantigens may have an important role in the pathogenesis. In this case report, a 10- year old boy is presented with signs of KAWASAKI DISEASE and despite receiving two high doses intravenous immunoglobulin, cervical lymph nodes continued to enlarge and finally lymph node biopsy revealed angioimmunoblastic like T cell lymphoma. Because the etiology of KAWASAKI DISEASE is unknown, if lymphadenopathy persists, other DISEASEs like lymphoma should be considered.    

Background: KAWASAKI DISEASE (KD) is a vasculitis that affects multiorgan systems such as liver and kidney. The diagnosis of the KAWASAKI DISEASE is made by clinical criteria. Sterile pyuria, microscopic hematuria, and proteinuria due to renal involvement present in KAWASAKI DISEASE; liver abnormalities contain abnormal liver function tests, gallbladder hydrops, and hypoalbominemia. The aims of this study were to define frequency of liver and renal abnormalities in patients with KD that hospitalized in Zahedan ali ebne abitaleb hospital in 2006-2013.Methods: Paraclinical findings including serum and urine tests and gallbladder ulterasonography of 47 patients with KD hospitalized in Zahedan ali ebne abitaleb hospital from 2006 to 2013 were reviewed retrospectively.Findings: Forty seven patients were studied; liver abnormalities were found in 22 cases (46.8%), impaired liver function tests were more common than other liver abnormalities in our study. The incidence of abnormal liver function tests in our studies was about 42%. Gallbladder hydrops were found in 9 patients (12.7%). Eighteen patients (38.3%) had renal involvement, sterile pyuria was the most common in our study, the incidence of steril pyuria was 36.2%. Microscopic hematuria and proteinuria were rarely found in our study; also blood urea nitrogen and creatinin had normal levels in all of children.Conclousion: KAWASAKI DISEASE should be considered in any infant or child with abnormal liver or renal function tests. Paraclinical findings of liver and renal involvement of our patients were partly similar to other articles we reviewed.

Background: Cardiac involvement that persists after KAWASAKI DISEASE is a major problem in the coarse of DISEASE and it is the leading cause of death. The aim of this study is to investigate the relationship between inflammatory markers (CRP, ESR, PLT) that are potential mediators for atherogenesis at the onset of DISEASE and coronary involvement as a sequelae and also the incidence of clinical manifestation in KAWASAKI DISEASE. Methods: A case-series study was performed to test the hypothesis that late coronary involvement is associated with elevated level of CRP, ESR & PLT at the onset of KAWASAKI DISEASE. A total of 36 patients (26 male and 10 female) were studied. All of them were treated with IVIG, and coronary involvement was studied with Echocardiography. Results: Levels of CRP, ESR and PLI were measured in all patients. Among 14 patients (38%) that had coronary involvement ESR level was above 90 in 71% patients, CRP levels were elevated in 92.9% and PLT count was elevated in 73% of patients. The results were analyzed by ANOVA, chi-square and Independent t-test and demonstrated that there is no valuable association between the level of ESR (p= 0.38), CRP (p=0.16), PLT count (p=0.11), and cardiac involvement. Among 36 patients the clinical manifestations were as follow: fever (100%). Oropharyngeal mucosal inflammation (88%). (lymphadenopathy (75%), skin rash (55%) and edema of the extremities (50%). Conclusion: The results demonstrate that there is no statistical association between the level of ESR, CRP and PLT with late cardiac involvement. It seems that further investigations in longer period of time are needed to confirm the relation between cardiac involvement and these laboratory tests.

Two infants, a boy and a girl aged 2.5 and 5 months, respectively, were admitted to Tehran's Children Hospital, for fever of unknown origin lasting for about two weeks. The boy presented with abdominal distention, diarrhea, irritability, pyuria, anemia, leukocytosis, thrombocytosis and raised titer of acute phase reactants. The girl presented with irritability, diarrhea and abdominal distention, Leukocytosis, thrombocytosis, anemia and elevated titer of acute phase reactants. All bacterial cultures and serological tests were negative. Cardiac echocardiography showed coronary artery aneurysm in both patients and confirmed the diagnosis of KAWASAKI DISEASE. These cases showed that atypical KAWASAKI DISEASE was often a late diagnosis and therefore should be quickly suspected in febrile young infants with abnormal inflammatory laboratory results without infection. Echocardiography is an important tool for diagnosis of atypical KAWASAKI DISEASE.