Kawasaki disease (also known as mucocutaneous lymph node syndrome) is a rare disease occurring in childhood in which walls of the blood vessels (veins, arteries, and capillaries) become chronically inflamed. Kawasaki disease is one the primary causes of heart disease in young children because if not promptly treated it can impact heart valve function.
Along with rheumatic heart disease, Kawasaki disease is the leading cause of acquired heart disease in young children in first world countries. Over 80% of all Kawasaki disease cases are reported in children under 5 years old with a high rate of cases in children of Asia ancestry. Japan has the highest incidence of the disease in the world. In fact, there were no reported cases outside of Japan until the 1970s. Kawasaki disease is not contagious or otherwise transmittable and its exact cause is unknown.
Kawasaki disease is less common than many other infectious diseases that affect young children. But Kawasaki disease is really not any longer considered a rare in the United States. Today, approximately 3000 children in the United States develop Kawasaki disease every year.
Four-five year has passed since Dr. Tomisaku Kawasaki first reported a case series of this disease. Yet the cause of this disease remains unknown.Symptoms of Kawasaki Disease
The initial symptom of Kawasaki disease is almost always a high fever that lasts for several days and is not responsible for fever-reducing medications. Additional early symptoms also include:
- Red, swollen eyes (without discharge)
- Significant rash on chest, abdomen and diaper area
- Red, cracked lips and red, swollen tongue
- Swelling and redness on palms of hands and bottom of feet
- Lymph node swelling (usually in the neck)
When the disease progresses to the 2nd stage, additional symptom may become noticeable. These phase 2 symptoms usually include:
- Peeling skin on feet and hands
- Pain in the joints
- Abdominal discomfort
- Vomiting and diarrhea
As the disease continues its progression into the 3rd phase, most of these symptoms may slowly disappear. Early diagnosis and treatment of Kawasaki disease are very important because allowing the disease to run its full course can result in permanent heart conditions.Treatment for Kawasaki Disease
To avoid the risk of heart complications, treatment of Kawasaki disease must be started very soon after the initial symptoms appear. Ideally, treatment should begin before the initial fever goes away. Treatment for Kawasaki disease focuses on reducing the fever and reducing the inflammation of the blood vessels. The first step in this treatment is usually gamma globulin.
Gamma globulin is an immune protein that is administered intravenously to lower the risk of heart and coronary damage from Kawasaki disease.
In addition to gamma globulin, treatment will also involve high doses of aspirin to reduce fever and inflammation. Aspirin is almost never given to children because of various risks, but the treatment of Kawasaki disease is one of the few exceptions to this.
Both the aspirin and gamma globulin can have serious complications and side effects, so treatment of Kawasaki disease with these options is usually done in the hospital.Diagnosing Kawasaki Disease
Diagnosing Kawasaki disease can be a lengthy process requiring the doctor to rule out a number of other conditions. Scarlet fever, juvenile arthritis, measles and several tick-borne illnesses can have similar symptoms to Kawasaki disease.
A number of lab test will be necessary to rule these conditions out. Urine and blood testing will rule out a number of other conditions. The blood work will also look at other signs of Kawasaki disease including elevated white blood cell count and signs of anemia.
A separate blood test will also be done to check for B-type natriuretic peptide (BNP). BNP is a chemical that is released into the blood when the heart is under stress. An electrocardiogram may also be done to look for abnormalities in the child's heartbeat and related electrical impulses. Most malpractice cases against doctors for Kawasaki disease are either pediatricians or emergency room doctors.Misdiagnosis of Kawasaki Disease - Malpractice Claims
Kawasaki disease is frequently misdiagnosed or not diagnosed right away. Since early treatment and intervention is key to avoiding long-term heart damage from Kawasaki disease, these types of diagnostic errors can have serious consequences. Failing to diagnose Kawasaki disease or misdiagnosing it as something else can amount to medical malpractice.
Diagnosing Kawasaki's disease is even more of a challenge in 2020 because COVID-19 can induce similar symptoms. Dr. Fauci has testified that this could ultimately cause a greater risk to our children then the low coronavirus rates in children thus far.
- A classic example of a Kawasaki disease misdiagnosis case
Summarized below are several older verdicts and reported settlements in medical malpractice cases involving a diagnosis of Kawasaki disease. These are not common lawsuits.
Naturally, there are also a lot of defense verdicts in these cases. In cases where the doctor prevailed, the child typically had an abnormal presentation of the disease.
Doe v ABC Doctors & Hospital (Ohio 2013) $2.5 million: Plaintiff took her 4-month-old baby to the pediatrician with fever, rash, red lips and other symptoms. The pediatrician immediately suspected Kawasaki disease and referred them to the hospital for further testing. Despite several tests and lab work, the hospital and its doctors concluded that it was not Kawasaki disease and discharged the baby. A week later they were back in the hospital at which time an echocardiogram confirmed that it was Kawasaki disease and it had already caused permanent coronary damage to the baby. Plaintiffs alleged that the failure to diagnose led to the delay in treatment that caused the coronary damage. The case settled for $2.5 million just prior to trial.
Bensfield v Loyola Univ Hosp (Illinois 2001) $1.2 million: Case alleged that doctors failed to consider Kawasaki disease in their differential diagnosis resulting in significant delay in making a correct diagnosis. Delayed treatment resulted in coronary damage requiring surgical repair. The case was settled for $1.2 million.
Dubler v Bethesda Memorial (Florida 2000) $1.2 million: Malpractice claims alleged that doctors misdiagnosed 4-year old with sinusitis when it was actually Kawasaki disease. Failure to diagnose led to lack of treatment and aneurysms of the coronary arteries ultimately requiring open heart surgery. The case settled for policy limits of defendant doctors.
If you have a child with Kawasaki disease who was not timely diagnosed, contact the medical malpractice attorneys at Miller & Zois to discuss your options and evaluate your case. Call us at 1.800.553.8082 or submit a request for a free consultation.