Recurrent Kawasaki disease in children: Four case reports

Recurrent Kawasaki Disease (RKD) is defined as the return of clinical symptoms, signs, and related laboratory indicators to normal after the last Kawasaki disease (KD) treatment, with an interval of at least 2 months from the last episode. Compared with initial KD, patients with RKD have a higher risk of developing refractory KD and coronary artery lesions (CALs). Our purpose of this study was to summarize the pathogenesis of RKD so clinicians can achieve early recognition and treatment. In this report, we described 4 children who developed KD for the second time. Case 1: A boy with 4 months between the two episodes of KD was diagnosed with refractory KD and received a second treatment of intravenous immunoglobulin (IVIG). Case 2: A girl with a family history of KD, with 20 months between the two episodes. She was diagnosed with Complete KD (CKD) and received first-line treatment. Case 3: A girl with 2 years between the two episodes was diagnosed with Incomplete KD (IKD), and underwent targeted sequencing of multiple pathogens in the upper respiratory tract due to 3 pathogenic infections and received first-line treatment. Case 4: A boy with 5 years between onset of the disease and diagnosis of IKD. C-reactive protein was significantly elevated at the time of admission, and he received IVIG combined with aspirin and methylprednisolone. All 4 children recovered after treatment without CALs. Children with a history of KD or infections with pathogens strongly associated with KD recurrence need to be assessed for RKD, regardless of the time interval.