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患儿男,日龄24天,因鼻塞、流涕5天,发热伴皮疹2天而收住。母孕史、生产史无殊,出生体重3.3kg,生后一切正常。5天前出现鼻塞流涕,2天前发热,体温39℃,当晚面部、躯干、四肢出现深红色皮疹,且逐渐增多。入院前曾用先锋V号抗炎及安乃近退热均无效。体检:神志清,体温39.2℃,心率146次/min,全身分布深红色皮疹.压之不褪色,密集如粟粒状,背部皮疹融合成片,局部有脱屑,皮疹无出血及感染迹象,颈部、颌下及腋下可触及数颗小淋巴结,口唇皲裂,口腔粘膜轻度充血,心肺听诊正常,肝肋下3.5cm,质软,脾未及。入院后实验室检查:血WBC23.5×10~9/L,N0.45、L0.55,血小板数469×10~9/L,ESR17mm/h,CRP 152.5mg/L,血清蛋白电泳Alb 55％,α_1 5％、α_2 20.1％、β8.3％、γ11.5％。肝功能及乙肝三系(一)、血培养(一)、IgG、IgA、IgM正常;胸片示右侧肺炎;心脏多普勒检查未见异常。人院后予先锋V号抗炎3天,热未退,3天后发现球结膜充血,肛周出现圆形脱屑,考虑川崎病。予阿斯匹林50mg,每日3次口服,加用丙种球蛋白1.5g静脉滴注每天1次,连续4天,预防冠脉瘤。次日热退,指趾出现典型的脱屑样改变,体温正常2周后改阿斯匹林5mg每日3次口服,但减量4天后体温又复升至39℃,发热持续7天,且无感染迹象,将阿斯匹林加
Children, aged 24 days, due to nasal congestion, runny nose 5 days, fever and rash 2 days and admitted. Maternal pregnancy history, the production history of special, birth weight 3.3kg, after birth, everything is normal. 5 days ago, stuffy nose and runny nose, fever 2 days ago, body temperature 39 ℃, the evening face, trunk, limbs appear crimson rash, and gradually increased. Vanguard V anti-inflammatory and analgesic antipyretic were used prior to admission. Physical examination: Consciousness, body temperature 39.2 ℃, heart rate 146 beats / min, the whole body distribution of deep red rashes. Pressure does not fade, densely miliary, back rash fusion into pieces, local desquamation, rash without bleeding and signs of infection, neck Department, submandibular and axillary palpable several small lymph nodes, chapped lips, oral mucosa mild congestion, cardiopulmonary auscultation normal, liver ribs 3.5cm, soft, spleen and. After admission, the laboratory tests showed that blood WBC23.5 × 10-9 / L, N0.45, L0.55, platelet count 469 × 10-9 / L, ESR17mm / h, CRP 152.5mg / L and serum protein electrophoresis Alb 55 %, Α_1 5%, α_2 20.1%, β8.3%, γ11.5%. Hepatic function and hepatitis B three lines (a), blood culture (a), IgG, IgA, IgM normal; right chest pneumothorax showed; no abnormalities Doppler examination. After the hospital to the Vanguard V anti-inflammatory 3 days, no heat back, 3 days after the bulbar conjunctival hyperemia, perianal appear round scaling, consider Kawasaki disease. To aspirin 50mg, 3 times a day orally, plus intravenous gamma globulin 1.5g intravenously 1 day for 4 days to prevent coronary aneurysms. Heat the next day, typical toe appear scaling changes, normal 2 weeks after the change aspirin 5mg 3 times a day orally, but the weight loss 4 days after the body temperature rose again to 39 ℃, fever continued for 7 days, And no signs of infection, add aspirin