Page 130 - Abstract Book KONIKA 18

Cardiology

P-CAR-027
Doctor, is it incomplete Kawasaki Disease?

Taufiq Hidayat , Sharifah Aishah Syed Ahmad Shihabuddin Abdurrahman Alsagoff ,
3
1,2
Muhammad Khairul Amri Yusoff 3
1
Mitra Delima Hospital, Malang, East Java, Indonesia ,
2
Department of Pediatrics, Kulliyyah of Medicine , Department of Pediatrics, Sultan Ahmad Shah Medical Centre,
International Islamic Universitas Malaysia, Malaysia 3
Abstract
Background Kawasaki disease (KD) is diagnosed when a patient has fever persisting for 5 days plus 4 of the
5 following criteria, ie. conjunctivitis, rash, erythema or edema of palms and soles, cervical lymphadenopathy,
and mucosal changes. Incomplete KD is a condition when clinical presentation suggestive of KD but not
meeting the full diagnostic criteria. It requires abnormal investigation results to support the diagnosis.Objective
To present a difficult case of incomplete KD. Case A 10-month-old girl was admitted due to fever for 6 days
associated with poor oral intake and injected throat. Then, she developed generalized maculopapular rash more
obvious on trunk and limbs. Few days later, we noted redness and swelling of her hands and feet. Her liver
was palpable 2cm below subcostal margin. Otherwise, there were no conjunctivitis, cervical lymphadenopathy,
cracked lips and strawberry tongue. BCG scar was absent upon examination. Echocardiography was normal
with both right and left coronary were smooth and size of 2.2-2.6mm. Blood investigation showed anemia
8.6g/dL, leukocytosis 21.2 x 10^9/L, normal platelet 440 x 10^9/L, increased CRP 76.7 mg/dL and ESR
120 mm/h, transaminitis with AST 590 U/L and ALT 491 U/L with hypoalbuminemia 2.5mg/dL. Abdominal
ultrasound showed distended gallbladder with thickened wall. IVIg was started and then fever subsided.
Patient was discharged with aspirin maintenance. Conclusion In case of suspected incomplete KD with
normal echocardiogram, positive three or more supplemental laboratory results such as leukocytosis, anemia,
hypoalbuminemia, and transaminitis are adequate criteria to start IVIg.
Keywords: incomplete Kawasaki Disease; echocardiography; intravenous immunoglobulin

P-CAR-028
Severe Tuberculos Pericardial Effusion in 10-year-old Boy

Adelgrit Trisia, Hana Christiani Sembiring, Meriah Sembiring, Khairiyadi
Department of Child Health Universitas Lambung Mangkurat, Banjarmasin, South Borneo, Indonesia

Abstract
Background In children, up to 25% of cases of tuberculosis (TB) are of extrapulmonary TB (EPTB).
Tuberculous pericardial effusion (TB-PE), a rare manifestation of EPTB, is the most common cause of
pericardial effusion in high-TB-burden settings. Objective To report a case of severe tuberculos pericardial
effusion in 10-years old boy. Case A 10 years old boy with history of fever since 5 weeks referred from
district hospital to Ulin Hospital with shortness of breath 1-week prior to admission. Shortness of breath was
not relieved by changing position, gets worse when activities, cough, pale without bleeding manifestation,
malaise, decreased of appetite with decreased body weight 2kg in 2 months. From physical examination,there
was a thinning and brittle hair, old face, pale conjunctiva, raised venous jugular pressure, muffled heart
sounds. Nutritional status was severe acute malnutrition with TB score 5. The electrocardiography revealed
sinus tachycardia with low voltage. The initial laboratory showed anemia, leukocytosis, neutrophilia,
elevated transamninase enzyme SGOT (298 U/L), SGPT (55 U/L). CRP (172 mg/l). The chest X-ray
defined cardiomegaly with susp pericardial effusion. PEs were classified according to echocardiography
large >10 mm, EF 54%. Pericardial fluid analylized PMN cell (+), elevated ADA test 58 U/L. Blood and
pericardial fluid culture result no microbial growth. Hematology malignancy excluded with normal BMP
and immunophenotyping. The patient was given anti tuberculosis therapy. The follow up echocardiography
after two months on tuberculosis therapy showed normal result. Conclusion Severe tuberculos pericardial
effusion resolved after given therapy and pericardiocentesis.
Keywords: extrapulmonary TB; pericardial effusion; pericardiocentesis

82 KONIKA XVIII Abstract Book