Clinical Analysis And Follow-up Of Recurrent Kawasaki Disease

ObjectiveTo investigate the clinical features，prognosis，prognostic factors ofrecurrent Kawasaki disease (KD).MethodsThe clinical data of77children with recurrent KD admitted toChildren’s Hospital of Chongqing Medical University from Jan.1994to Oct.2012were retrospectively studied and compared with their initialonset．Long-term followed-up was completed for children with recurrentKD.77KD patients hospitalized in2001-2007and without recurrence ofKD in5～10years after treatment were selected randomly as case-controlgroup, and potential risk factors for recurrence were analyzed.ResultsKD relapsed2months to7years (average1.6years) after the first onsetin the77children. Compared with the initial KD onset, the clinicalsymptoms were less severe and the total fever duration was remarkablyshorter in the recurrent KD group［(7.6±3.1)d vs (8.9±3.8)d，P＜0.05］. The levels of WBC and CRP were remarkably lower in the recurrent KDgroup［(14.3±5.7) vs (16.2±5.4)×109/L and (61±58) vs(95±76) mg/L, P＜0.05)］. The incidence of CAL did not increase compared with the initialKD group (13.3%vs17.8%，P＞0.05) in the acute stage.7cases weredetected CALs at first onset and recurrence, including1case with CAA ininitial onset and recurrence.52cases of77recurrent cases with recurrent KDwere effectively followed up for6months to6years and5months.1case ofrecurrence with small CAA appeared coronary artery dilatation at differentlocation during the follow-up，with recurrent coronary artery dilating after4years and7months. Multiple Logistic regression analysis showed that age<3years, sex, fever duration>10d, CAL, white blood cell counts>20.00×109/L were not the independent risk factors of KD recurrence.ConclusionsThe initial patients with KD less than3years old are more likely torelapse, and the interval between the two episodes of KD recurrence ismostly within1year. The clinical manifestations of recurrent KD are similarto initial KD, but the clinical symptoms were incomplete and morecomplicated. Recurrent KD may be not associated with an increasedincidence of CAL， which may due to early recognition and timelytreatment．We should stress on close follow-up for patients with recurrentKD complicated with coronary artery lesion．Coronary artery dilation mayoccur in a new part or relapse after retraction in the acute stage.