Clinical aspects of splenomegaly as a possible predictive factor of coronary artery changes in Kawasaki disease

Abstract

Background: Although many clinical features that are not typically included in the diagnostic criteria for Kawasaki disease, such as gall bladder hydrops, are known to occur with Kawasaki disease, splenomegaly is not concerned. We investigated the relationship of splenomegaly with the development of coronary artery lesions in Kawasaki disease.

Methods and results: This retrospective descriptive study was conducted through a review of medical records of children with Kawasaki disease from March 2011 to February 2017. We analysed information regarding clinical presentation, treatment, hospital stay, and outcome. A total of 396 patients during this 6-year period met the enrolment criteria. Of these, 77 (23.4%) underwent abdominal ultrasonography during the treatment period. The patients included 46 males and 31 females with an average age of 35.8 ± 26.1 months. Gallbladder hydrops were detected in 32 patients, and acute acalculous cholecystitis was not found. Splenomegaly was detected in 21 patients. Kawasaki disease patients with gallbladder hydrops had no statistical difference in clinical or laboratory findings or in development of coronary artery lesions compared to patients without gallbladder hydrops. However, patients with splenomegaly belonged more to incomplete Kawasaki disease, had longer fever duration, had more frequent cervical lymphadenopathy and polymorphous rash, had higher neutrophil percentage, N-terminal fragment of pro-brain natriuretic peptide, and alanine aminotransferase levels, and a higher incidence of coronary artery lesions than patients without splenomegaly.

Conclusion: Splenomegaly belongs to incomplete Kawasaki disease patients mainly with a higher incidence of coronary artery lesions than that of patients without it.

Keywords: Kawasaki disease; coronary artery lesions; splenomegaly.