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    Pediatrics
    December 2003, VOLUME 112 / ISSUE 6
    ELECTRONIC ARTICLES

    Are Children With Kawasaki Disease and Prolonged Fever at Risk for Macrophage Activation Syndrome?

    Aleixo Muise, Susan E. Tallett, Earl D. Silverman
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    Tables

    • TABLE 1.

      Changes in Laboratory Values During Course of Illness

      DayAt PresentationOnset MAS48 Hours LaterAt Discharge2 Months Later
      White blood count (4–10 109/L)24.1 × 109/L (103/μl)10.2 × 109/L (103/μl)19.7 × 109/L (103/μl)6.8 × 109/L (103/μl)12.9 × 109/L (103/μl)
      Polys (2.00–7.50 109/L)20.5 × 109/L (103/μl)2.68 × 109/L (103/μl)14.43 × 109/L (103/μl)5.04 × 109/L (103/μl)11.1× 109/L (103/μl)
      Lymph (1.5–7.0 109/L)0.96 × 109/L (103/μl)0.20 × 109/L (103/μl)0.93 × 109/L (103/μl)1.02 × 109/L (103/μl)1.3 × 109/L (103/μl)
      Hemoglobin (120–160 g/L)113 g/L (11.3 g/dL)85 g/L (8.5 g/dL)93 g/L (9.3 g/dL)101 g/L (10.1 g/dL)136 g/L (13.6 g/dL)
      PLT (150–400 109/L)623 × 109/L (103/μl)104 × 109/L (103/μl)133 × 109/L (103/μl)464 × 109/L (103/μl)293 × 1109/L (103/μl)
      Erythrocyte sedimentation rate (1–10 mm/hour)118 mm/hour70 mm/hour53 mm/hour36 mm/hour1 mm/hour
      AST (0–36 units/L)105 units/L2083 units/L1339 units/L96 units/L26 units/L
      ALT (0–40 units/L)12 units/L903 units/L951 units/L79 units/L31 units/L
      ALK Phos (180–475 units/L)121 units/L339 units/L247 units/L111 units/L51 units/L
      Conj. bili (0–2 μmol/L)0 μmol/L (0 mg/dL)10 μmol/L (0.58 mg/dL)1 μmol/L (0.06 mg/dL)0 μmol/L (0 mg/dL)N/A
      Unconj. bili (0–17 μmol/L)0 μmol/L (0 mg/dL)0 μmol/L (0 mg/dL)0 μmol/L (0 mg/dL)1 μmol/L (0.06 mg/dL)N/A
      LDH (432–700 units/L)N/A29691 units/L5062 units/LN/AN/A
      Ferritin (22.0–400 μg/L)N/A1156 μg/L1256 μg/LN/AN/A
      Fibrinogin (1.60–4.00 g/L)N/A0.47 g/L0.76 g/L4.41 g/LN/A
      D-Dimer (0–499 ng/L)N/A5420 ng/L1970 ng/L2160 ng/L429 ng/L
      Triglyceride (0.40–1.30 mmol/L)N/A2.52 mmol/L (223 mg/dL)2.80 mmol/L (248 mg/dL)N/AN/A
      Albumin (33–58 g/L)N/A28 g/L (2.8 g/dL)23 g/L (2.3 g/dL)N/AN/A
      • Laboratory values with normal SI unit values in brackets are shown. N/A indicates not available; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALK phos, alkaline phosphatase; PLT, platelet; conj. bili, conjugated bilirubin; unconj. bili, unconjugated bilirubin.

    • TABLE 2.

      Comparison of Patients With KD Who Developed MAS

      Patient1 (Ohga et al9)2 (Kaneko et al8)3 (Al-Eid et al7)4 (Present Case)
      Age32 mos12 mos6 y9 y
      GenderMaleFemaleMaleMale
      Days to MAS21242023
      Number of courses of IVIG3522
      CorticosteroidNoneNone1 course of IVMP2 courses of IVMP followed by oral therapy
      Laboratory evidence of MAS
       CytopeniaYesYesYesYes
       HyperferritinemiaYesYesYesYes
       Elevated LDHYesN/AYesYes
       Elevated acyl-transferasesN/AYesYesYes
       HypofibrinogenemiaNoN/AYesYes
       HypertriglyceridemiaN/AN/AYesYes
      Evidence of MAS by biopsyBone marrowBone marrowLiverBone marrow
      • IVMP indicates intravenous methylprednisolone; N/A, not available.

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    Are Children With Kawasaki Disease and Prolonged Fever at Risk for Macrophage Activation Syndrome?
    Aleixo Muise, Susan E. Tallett, Earl D. Silverman
    Pediatrics Dec 2003, 112 (6) e495-e497;

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    Are Children With Kawasaki Disease and Prolonged Fever at Risk for Macrophage Activation Syndrome?
    Aleixo Muise, Susan E. Tallett, Earl D. Silverman
    Pediatrics Dec 2003, 112 (6) e495-e497;
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