The Clinical Characteristics of Recurrent Kawasaki Disease

재발한 가와사끼병의 임상적 특징

Purpose : The purpose of this study is to investigate the clinical characteristics of recurrent Kawasaki disease (KD). Methods : From January 2004 to December 2007, the medical records of 20 children with recurrent KD in Severance Children's Hospital were retrospectively reviewed. The clinical characteristics, laboratory findings, treatment and complications of these patients were compared between the initial episode and the second episode. Results : At the initial episode of the recurrent KD group, the gender ratio was 1.2:1 (male:female) and the mean age was $37.2{\pm}19.9$ months. The interval between the two episodes in the recurrent KD group was 3.3 months. The febrile period before admission was shorter for the second episode (P=0.034). The skin rash was less developed in the second episode. But there were no differences in the laboratory results and complications between the initial episode and the second episode. Three patients (15%) among those with a second episode failed to respond to the initial intravenous immunoglubulin treatment. On comparison between the initial episodes of the recurrent group and the nonrecurrent group, the erythrocyte sedimentation rate was higher in the first episode of the recurrent KD group. Conclusions : For recurrent KD, it tends to present more atypical features than the KD that occurs for the first time. Physicians should consider these characteristics when making the diagnosis and treating recurrent KD.

목 적 : 가와사끼병의 재발에 있어서의 임상양상 및 관련된 인자를 찾아보고자 하였다 방 법 : 2004년 1월부터 2007년 12월까지 세브란스 어린이병원 소아청소년과에서 가와사끼병으로 2회이상 치료받은 환아 20명을 대상으로 하여 초기 발병시와 재발시의 입원기록을 후향적으로 비교분석 하였다. 결 과 : 재발한 가와사끼병 환자 20명의 남여 성비는 1.2:1이었으며 평균연령은 $37.2{\pm}19.9$개월이었고, 재발 간격은 평균 3.3개월이었다. 첫 발병시보다 재발시에 발열 기간이 더 짧았고 발진이 적었으나 혈액학적 소견, 치료 결과 및 합병증은 차이가 없었다. 재발시 3명(15%)에서 정맥용 면역글로불린 초기치료에 반응하지 않았다. 재발 하지 않은 그룹에 비해 재발한 그룹에서 적혈구 침강속도 수치가 더 높았다. 결 론 : 가와사끼병은 재발하는 경우에는 비전형적 가와사끼병으로 표현될 수 있으므로 소아청소년과 의사는 이런 특징을 유념하여 진단과 치료를 수행하여야 할 것이다.