CEREBROSPINAL-FLUID PROFILE IN PATIENTS WITH ACUTE KAWASAKI-DISEASE

Background. Kawasaki disease (KD) is an acute vasculitis of infancy an d early childhood for which there is currently no diagnostic test. The clinical presentation of KD may initially resemble other infectious d iseases, including bacterial or viral meningitis. For this reason lumb ar puncture (LP) is sometimes performed during the evaluation of these patients. To understand the range of cerebrospinal fluid (CSF) change s that may be associated with acute KD, a retrospective review of unse lected KD patients from three pediatric centers was performed. Methods . Retrospective chart review was performed on KD patients evaluated du ring the first 10 days of illness who had an LP performed before the a dministration of intravenous gamma-globulin. Results. During the 6.5-y ear study period, 46 KD patients underwent LP as part of their clinica l evaluation, Of these patients 18 (39.1%) had CSF pleocytosis, 1 (2.2 %) had a CSF glucose <45 mg/dl and 8 (17.4%) had an elevated CSF prote in. Of the patients with CSF pleocytosis, the median white blood cell count was 22.5 cells (range, 7 to 320 cells), with a median of 6.0% ne utrophils (range, 0 to 79%) and 91.5% mononuclear cells (range, 11 to 100%). Conclusions. In the present series approximately one-third of K D patients who underwent an LP had CSF pleocytosis with a mononuclear cell predominance. No patient had significant hypoglycorrhachia, and e levation of the CSF protein was uncommon. CSF abnormalities were simil ar between US and Japanese KD patients. The basis for the CSF pleocyto sis in acute HD patients remains unknown.