Page 120 - Abstract Book KONIKA 18

Cardiology

P-CAR-007
The Lymph-Node-First Presentation of Kawasaki Disease: A Case Report

Hana Christiani Sembiring , Okky Prasetyo , Meriah Sembiring , Vienna Rosalinda 2
1
1
1
Department of Child Health and Department of Cardiology , Universitas Lambung Mangkurat/Ulin General Hospital,
2
1
Banjarmasin, South Borneo, Indonesia
Abstract
Background The lymph-node-first presentation of Kawasaki disease (KD) is rare and difficult to differentiate
with bacterial cervical lymphadenitis. There might be delay in management KD appropriately and increase
the risk of developing coronary artery disease. Objective To report the case of lymph-node-first presentation
of KD. Case A 2 years old boy was referred to Ulin Hospital with history of 10 days of fever and enlargement
of the left cervical lymph node. He had been hospitalized for about 7 days in a private hospital with diagnosis
of suppurative lymphadenitis and treated by multiple antibiotics without any clinical improvement. There
were bilateral non-exudative conjunctival injections, hyperemic lips and skin desquamation in the past
two days. The previous laboratory suggested to possible KD including leukocytosis, thrombocytosis,
elevated SGOT, high CRP, mild hypoalbuminemia with CRP to albumin ratio was 9.54. The fine needle
biopsy showed the pattern of chronic nonspecific lymphadenitis. At Ulin Hospital, the electrocardiography
showed sinus tachycardia and juvenile T-wave pattern. The echocardiography revealed dilatation of left
coronary artery (LCA) 4.49 mm and right coronary artery (RCA) 2.64 mm. The patient was treated by
Intravenous Immunoglobulin (IVIG), given over 12 hours with a high dose of aspirin. After 24 hours of
IVIG administration, the fever subsided and the size of lymph nodes was decreased. The aspirin dose was
reduced for 6 weeks. Routine echocardiography was planned for monitoring dilatation of coronary arteries.
Conclusion Kawasaki disease should be suspected in children who are unresponsive to antibiotics with
prolonged fever and cervical lymphadenitis.
Keywords: Kawasaki disease; fever, lymphadenitis

P-CAR-008
A Case Report and Brief Literature Review of Acute Rheumatic Fever

Wanda Gautami, Mulyadi M. Djer
Department of Child Health, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital,
Jakarta, Indonesia
Abstract
Background Acute rheumatic fever can result in rheumatic heart disease. The diagnosis of acute rheumatic
fever is entirely clinical, without any laboratory gold standard. No treatments have been shown to reduce
progression of rheumatic heart disease. Therefore, appropriate knowledge regarding diagnostic approach,
treatment and prevention of acute rheumatic fever is important, as its incidence is high in developing
countries such as Indonesia. Objective To report a patient with acute rheumatic fever followed by a brief
discussion on the epidemiology, pathogenesis, diagnosis and treatment. Case A 7-year-old male patient
presented with migratory polyarthritis without any other symptoms. On physical examination, there was
a holosystolic murmur grade 3/6 with punctum maximum at the 5th intercostal space left midclavicular
line, radiating towards axilla, louder when the patient tilts his body to the left, and coarsened in quality,
suggestive for mitral regurgitation. Echocardiography result confirmed mitral regurgitation, also dilatation of
left atrial and left ventricle. Laboratory examination revealed increased anti-streptolysin O titer, erythrocyte
sedimentation rate, and C-reactive protein. He was given benzathine penicillin G to eradicate possible current
streptococcal infection, also prednisone and aspirin to treat carditis. Two weeks after initial evaluation, there
were improvement of carditis in both physical examination and echocardiography, and also improvement in
symptoms of arthritis. The patient was then discharged with aspirin prescription. Regular benzathine penicillin
G every 3 weeks was planned until the age of 21 years as secondary prevention to prevent streptococcal
infection, thus preventing recurrence of acute rheumatic fever. Conclusion Early detection and treatment
of acute rheumatic fever is needed to prevent the risk of complications.
Keywords: acute rheumatic fever, diagnosis, treatment

72 KONIKA XVIII Abstract Book