误诊为川崎病八例原因剖析

Analysis of 8 Cases Misdiagnosed as Kawasaki Disease

目的探讨其他疾病误诊为川崎病(Kawasaki disease,KD)的原因及防范措施。方法对曾误诊为KD 8例的临床资料进行回顾性分析。结果本组8例均出现发热,其中7例伴皮疹、2例伴腹痛、1例伴四肢关节肿痛、1例伴咳嗽入院。8例均曾误诊为KD,误诊时间7~91(31.5±24.2)d。8例中经血培养及脑脊液高通量基因检测、彩色多普勒超声检查明确诊断布鲁杆菌病合并脑炎和血管炎1例;经淋巴结活组织病理检查确诊为组织细胞坏死性淋巴结炎1例;根据病史特点、体格检查及实验室检查,排除其他疾病,明确诊断全身型幼年特发性关节炎6例,其中2例经实验室检查明确合并巨噬细胞活化综合征。8例确诊后均给予相应治疗病情好转出院。随访病情稳定。结论对此类疾病认识不足、诊断经验欠缺和未能详细询问病史是导致其他疾病误诊为KD的主要原因。进一步了解和学习与KD相关疾病知识,完善各项检查,详细询问病史,并仔细鉴别诊断,或可减少或避免此类疾病误诊误治。

Objective To analyze the causes and preventive measures of other diseases misdiagnosed as Kawasaki disease(KD).Methods The clinical data of 8 cases misdiagnosed as KD were retrospectively analyzed.Results All 8 cases in this group developed fever,including 7 cases accompanied with rash,2 with abdominal pain,1 with swelling and joint pain of limbs,and 1 with cough.All 8 cases were misdiagnosed as KD with a duration of misdiagnosis for 7-91(31.5±24.2)d.Among 8 cases,1 case of brucellosis with encephalitis and vasculitis was definitely diagnosed by blood culture,high-throughput gene detection of cerebrospinal fluid and vascular ultrasound;1 case was diagnosed as histiocytic necrotizing lymphadenitis through pathological examination of lymph node biopsy.According to the medical history,physical examination and laboratory examination,other diseases were excluded,and 6 cases of systemic juvenile idiopathic arthritis(SJIA)were clearly diagnosed,of which 2 cases were combined with macrophage activation syndrome(MAS)by laboratory examination.After the diagnosis of 8 cases,they were given corresponding treatment and discharged after their condition was improved.They were followed up with stable condition.Conclusion Insufficient knowledge of such diseases,lack of experience and failure to inquire about detailed medical history are the main causes of misdiagnosis of other diseases as KD.Further study and understanding of the knowledge of KD-related diseases,various examinations,detailed medical history inquiry and careful differential diagnosis may help reduce or avoid misdiagnosis and mistreatment of such diseases.