PMC6944459_01
Image examinations on day 8 of illness. A: Chest X-ray. The cardio-thoracic ratio was 0.53 and congestion was observed in the hilum of both lungs.. B and C: Echocardiograms. The left ventricular ejection function was 39%, percent fractional shortening was 20.9%, and the left ventricular end-diastolic dimension was 33.9 mm (104% larger than in a normal case).
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We found congestion on the chest X-ray scans that were taken on day 8 of the illness (Fig. 1A). In her echocardiography, on day 8 of the illness, the left ventricular ejection fraction was 39% and mild mitral regurgitation was detected, indicating left heart failure (Fig. 1B).
Electroencephalograms. A: Slow waves of activity in all brain regions, especially in the occipital lobe, were observed on day 8 of illness. B: Abnormal waves were recovered on day 18 of illness.
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The electroencephalogram (EEG) showed slow waves of activity in all regions of the brain, especially in the occipital lobe (Fig. 2A), although magnetic resonance imaging (MRI) scans of the brain were normal. On day 18 of the illness, the EEG showed improvement of slow waves (Fig. 2B), and on day 19, she was able to walk.
Clinical course. Treatments with IVIG (2 g/kg), aspirin (30 mg/kg/day), ulinastatin (5000 units/kg/dose, four times a day), and furosemide (1 mg/kg/dose, three times a day) were started on day 7 of illness. A continuous administration of dobutamine (2 mug/kg/min) was required, because of her low blood pressure. PE therapy was started on day 8 of illness because of left ventricular failure and acute encephalopathy. Due to the recurrence of the fever and EEG abnormalities, MP and IVIG were administered from day 11 of illness. Due to the combination therapy of IVIG, PE, and MP the symptoms of the patient improved.. BT: body temperature, CK: creatine kinase, CRP: C-reactive protein,. EEG: electroencephalogram, IVIG: intravenous immunoglobulin, KD:. Kawasaki disease, MP: methylpredonine pulse therapy, NT-proBNP:. N-terminal pro-brain natriuretic peptide, PE: plasma exchange,. WBC: white blood cell.
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As the progression of KD was getting worse, PE was started on day 8 of the illness and was repeated for three days (Fig. 3).