Background Kawasaki disease (KD), an acute febrile childhood vasculitis can present with varying clinical features and the main complication is involvement of coronary arteries (1). The epidemiological pattern may be different in different geographical regions, even it can vary within a country. KD is not unusual in India but published series are infrequent (2). Here we present a series of 145 cases of KD diagnosed in our hospital in last 6 years to have a look in to the varied clinical manifestations, epidemiology, atypical features and complications.

Objectives 1. To analyse the record of Kawasaki disease diagnosed in the study period. 2. Compare the epidemiology and clinical features of KD in our part of the country with that of the published series from northern India. 3. To note the atypical features and estimate the incidence of coronary involvement.

Methods Clinical records of 145 children fulfilling the diagnostic criteria of Kawasaki Disease and admitted at the Institute of Child Health, Kolkata during the time period October 2008 to December 2014 were reviewed. The data collected included details of clinical and laboratory features, treatment and outcome.

Results A total of 145 patients were diagnosed as KD (5 per 1000 hospital admission). Among these 145 patients,136 presented with typical features of KD, rest 9 were atypical including KD with erythroderma, KD with bilateral ptosis, neonatal KD, KD with nephrotic syndrome etc. Average age of presentation was 25 months. Most patients presented with fever of an average duration of 9 days. Besides the typical features, we want to stress upon some special features of KD, like orange-brown chromonychia (orange brown discolouration of nails) in 65% of cases, BCG scar reactivation in 15%, extreme irritability in 88% and greenish loose stools in about 64%. Echocardiographic abnormalities (ectasia or aneurysm) were detected in 31% of cases. All patients received Intravenous Immunoglobulin of which 6 did not respond to a single dose of 2gram/kg.

Conclusions 1. A bimodal seasonality has been seen with clustering of cases during March- April and September-October. 2. Mean age of onset (23 months) is lower than the north India series. 3. Most (94%) presented with typical form with a response rate of 96% with first dose ivIg. 4. Orange brown Chromonychia is a novel finding that has been seen in a significant number of patients. 5. Coronary abnormalities is on the higher side than the reported series from north India as well as other parts of the world.

References

1. Kawasaki T. General review and problems in Kawasaki disease. Jpn Heart J 1995; 36: 1-12.

2. Singh S, Bansal A, Gupta A, Manojkumar R, Mittal BR. Kawasaki Disease – a decade of experience from North India. Int Heart J 2005; 46: 679-689.

Acknowledgements Dr. Apurba Ghosh, professor & Director,Institute OfChild Health,Kolkata.

Disclosure of Interest None declared