Int J Clin Pediatr

International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access

Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc

Journal website https://www.theijcp.org

Case Report

Volume 10, Number 1, March 2021, pages 10-17

Kawasaki Disease Shock Syndrome: A Challenging Diagnosis

Figures

Figure 1. Rash of the lower limbs.

Figure 2. Pulmonary ultrasound showing anechogenic pleural effusion with sinusoid sign (M-mode). The sinusoid sign (*) is a dynamic sonographic sign, present when respiratory variation decreases the distance between the parietal and visceral pleura, when separated by a pleural effusion.

Figure 3. Transthoracic echocardiography demonstrating an aneurysmatic dilatation (4.7 mm) at the beginning of the right coronary artery (white arrow).

Figure 4. Transthoracic echocardiography demonstrating a rosary aneurysmatic dilatation of the left coronary artery (white arrow).

Figure 5. Transthoracic echocardiography demonstrating a dilatation of left main coronary artery (3.7 mm).

Figure 6. Abdominal ultrasound, with thickening of the terminal ileum and large amount of peritoneal effusion (++).

Table

**Table 1.** Summary of Blood Results During Inpatient Admission
	D1	D3	D5	D11	D15	D17	D20	D24
BUN: blood urea nitrogen; CRP: C-reactive protein; GOT: glutamic oxaloacetic transaminase; GPT: serum glutamic pyruvic transaminase; INR: international normalized ratio; LDH: lactate dehydrogenase; NT-proBNP: N-terminal pro B-type natriuretic peptide.
White cell count (× 10⁹/L)	26.47	34.27	27.97	13.58	10.25	8.83	8.93	8.67
Neutrophils (× 10⁹/L)	22.31	27.42	25.15	10.12	3.97	2.57	4.47	3.81
Lymphocytes (× 10⁹/L)	3.52	5.14	2.55	3.1	5.71	5.61	4.00	4.03
Hemoglobin (g/L)	9.3	7.8	10.5	9.7	7.4	7.8	7.1	8.1
Platelets (× 10⁹/L)	118	47	21	550	215	251	327	301
INR	1.52	1.3	1.4	1.6	1.3	1.1	1.1	1.0
CRP (mg/L)	28.8	30	18.14	13.06	1.6	0.16	1.54	0.43
GOT/GPT (U/L)	537/84	222/111	250/144	40/72	31/42	54/69	31/50	19/34
Fibrinogen (mg/dL)	722	120	150	249	93	87	-	-
Albumin (U/L)	21	23	25	29	30	27	30	32
Creatinine (mg/dL)	0.52	0.77	0.60	0.40	0.42	0.34	0.32	0.36
BUN (mg/dL)	31	60		21	21	15	13	12
LDH (U/L)	537	873	687	310	305	222	-	212
Triglycerides (mg/dL)	76	105	-	-	-	-	-	-
Ferritin (ng/mL)	722	2,217	5,070	822	-	-	-	-
Troponin (ng/L)	-	404.4	-	-	-	13.1	8.8	2.3
NT-proBNP (ng/L)	-	> 35,000	-	-	-	4,875.4	183.6	994.2