A Case of Refractory Atypical Kawasaki Disease with Pericardial and Hemorrhagic Pleural Effusion

Kawasaki disease (KD) combined with pericardial and hemorrhagic pleural effusion is very rare. We report the case of refractory atypical KD in 10-months-old infant who was initially manifested in fever, nonsuppurative conjunctival injection, red fissured lip, BCG site injection, respiratory failure and gastrointestinal symptoms. She was noted pericardial and pleural effusion in echocardiogram, so we did pericardiocentesis and thoracentesis, and exudate pericardial and hemorrhagic pleural effusion were revealed. Treatment with infliximab after the failure of high dose methylprednisolone and repeated intravenous immunoglobulin therapy, resolved KD symptoms and pleural effusion. Echocardiogram showed normal coronary arteries during and after the entire treatment period. This case would help clinicians recognize initial presentation of atypical KD with pericardial and hemorrhagic pleural effusion.

Figure 1 Frontal view of the chest radiograph shows pleural effusion at right thorax with cardiomegaly.

Figure 2 The four-chamber view of echocardiogram shows pericardial effusion.