Timeline.
| Timeline | Intervention |
|---|---|
| Seventy-two hours before admission | 1st dose of the hexavalent routine immunization |
| Day 1: 48 hours before admission | Pyrexia up to 40°C |
| Day 3: admission, pyrexia, bulging fontanelle, diffuse maculopapular rash | Lumbar puncture, cefotaxime 200 mg/kg/day for 7 days total |
| Day 4: rash, diagnosis of “incomplete” Kawasaki | IVIG 2 g/kg |
| Day 5: pyrexial | Aspirin 80 mg/kg/day, also gentamycin 7.5 mg/kg/day and omeprazole 2 mg/kg/day |
| Day 7: peripheral oedema, scrotal swelling | - |
| Day 9: relapse pyrexia 38.2°C | Prednisolone po 2 mg/kg/day |
| Day 10: fever subsided | Change antibiotics to ampicillin-clavulanate |
| Day 11: desquamation of the fingers | - |
| Day 13: cardiac echocardiography | Generalized dilation of the coronary arteries. LCA 2.3 mm, z score 2.9; LAD 2.2 mm, z score 3.87 |
| Day 14: new onset of pyrexia 37.7°C | Transferred to our centre. Aneurysm LCA 2.6 mm, LAD 3.4 mm, RCA 3.1 mm |
| Day 15 | Second dose IVIG 2 g/kg, methylprednisolone 2 mg/kg, anakinra 8 mg/kg, infliximab 25 stat |
| Day 17: apyrexial | Commenced SC tinzaparin 1,000 IU × 1 |
| Day 19 | Decrease methylprednisolone 1.5 mg/kg, SC anakinra 4 mg/kg |
IVIG: intravenous immunoglobulin; LAD: left anterior descending; LCA: left coronary artery; po: per os; RCA: right coronary artery; SC: subcutaneous; -: no data.
AA and NA: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. ET: Resources, Supervision. MT: Resources, Writing—review & editing. NGE: Validation, Writing—review & editing, Supervision. All authors read and approved the submitted version.
The authors declare that they have no conflicts of interest.
The study was approved by the Ethics Committee of Agia Sofia Children’s Hospital Reference Number 5893/2022, and complies with the Declaration of Helsinki.
Informed consent to participate in the study was obtained from the participant’s guardians.
Informed consent to publication was obtained from relevant participant guardians.
The data of this manuscript could be available from the corresponding authors upon reasonable request.
Not applicable.
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