Acute cholestasis: Atypical onset of Kawasaki disease

Valentini, Piero; Ausili, Emanuele; Schiavino, Alessandra; Angelone, Donatella Francesca; Focarelli, Benedetta; Rosa, Gabriella De; Ranno, O

doi:10.1016/j.dld.2007.10.010

Cited by 37 publications

(30 citation statements)

References 9 publications

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“…Digestive tract involvement is reported in approximately 20–35% of cases [1, 9, 10, 11, 12] with different clinical manifestations (vomiting, diarrhea, abdominal pain, abdominal distension, jaundice, paralytic ileus, hepatomegaly, hydrops of gallbladder, and, much less frequently, pancreatitis, gastrointestinal obstruction/ pseudo-obstruction) and echographic findings. Gastrointestinal symptoms at KD onset can complicate clinical recognition [12, 13, 14], lead to unnecessary surgical interventions and cause therapeutic delay, thus increasing the risk of CALs. To date, no multicenter study has investigated whether the presence of clinical abdominal involvement is a marker of more severe disease.…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal presentation of Kawasaki disease: A red flag for severe disease?

et al. 2018

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BackgroundKawasaki disease (KD) is a febrile systemic vasculitis of unknown etiology and the main cause of acquired heart disease among children in the developed world. To date, abdominal involvement at presentation is not recognized as a risk factor for a more severe form of the disease.ObjectiveTo evaluate whether presenting abdominal manifestations identify a group at major risk for Intravenous immunoglobulin (IVIG)-resistance and coronary lesions.MethodsRetrospective study of KD patients diagnosed between 2000 and 2015 in 13 pediatric units in Italy. Patients were divided into 2 groups according to the presence or absence of abdominal manifestations at onset. We compared their demographic and clinical data, IVIG-responsiveness, coronary ectasia/aneurysms, laboratory findings from the acute and subacute phases.Results302 patients (181 boys) were enrolled: 106 patients with, and 196 patients without presenting abdominal features. Seasonality was different between the groups (p = 0.034). Patients with abdominal manifestations were younger (p = 0.006) and more frequently underwent delayed treatment (p = 0.014). In the acute phase, patients with abdominal presentation had higher platelet counts (PLT) (p = 0.042) and lower albuminemia (p = 0.009), while, in the subacute phase, they had higher white blood cell counts (WBC) and PLT (p = 0.002 and p < 0.005, respectively) and lower red blood cell counts (RBC) and hemoglobin (Hb) (p = 0.031 and p 0.009). Moreover, the above mentioned group was more likely to be IVIG-resistant (p < 0.005) and have coronary aneurysms (p = 0.007). In the multivariate analysis, presenting abdominal manifestations, age younger than 6 months, IVIG- resistance, delayed treatment and albumin concentration in the acute phase were independent risk factors for coronary aneurysms (respectively p<0.005, <0.005, = 0.005 and 0.009).ConclusionsThis is the first multicenter report demonstrating that presenting gastrointestinal features in KD identify patients at higher risk for IVIG-resistance and for the development of coronary aneurysms in a predominantly Caucasian population.Clinical trial registration8/20014/O/OssN.

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Section: Introductionmentioning

confidence: 99%

Gastrointestinal presentation of Kawasaki disease: A red flag for severe disease?

et al. 2018

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“…Various mechanisms have been proposed to explain cholestasis in KD. Obstruction due to vasculitis or enlarged lymph nodes at porta hepatis, cystic duct wall oedema, inflammation of liver and gallbladder serosa or intrahepatic cholangitis 16,17 are among them.…”

Section: Discussionmentioning

confidence: 99%

An atypical case of Kawasaki disease presenting with cholestatic jaundice

Perera

Samarasinghe

Pathirana

et al. 2015

Sri Lanka J Child Health

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“…It was postulated that a vasculitis of KD by the inflammatory changes of liver and gallbladder, and obstructive mechanism with enlarged lymph nodes gave cause to cholestasis. 6 In a study that reviewed acute febrile cholestatic jaundice, KD was found as the second most frequent (20%) cause among the 24 children. All of these patients had presented with hepatomegaly, elevated acute phase reactants, aminotransferase levels and cholestatic markers.…”

Section: Discussionmentioning

confidence: 99%

Two cases of Kawasaki disease presented with acute febrile jaundice

Kaman¹,

Aydın-Teke²,

Gayretli-Aydın³

et al. 2017

Turk J Pediatr

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Kawasaki disease is an acute, systemic vasculitis of unknown etiology. Although gastrointestinal involvement does not belong to the classic diagnostic criteria; diarrhea, abdominal pain, hepatic dysfunction, hydrops of gallbladder, and acute febrile cholestatic jaundice are reported in patients with Kawasaki disease. We describe here two cases presented with fever, and acute jaundice as initial features of Kawasaki disease.

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Acute cholestasis: Atypical onset of Kawasaki disease

Cited by 37 publications

References 9 publications

Gastrointestinal presentation of Kawasaki disease: A red flag for severe disease?

Gastrointestinal presentation of Kawasaki disease: A red flag for severe disease?

An atypical case of Kawasaki disease presenting with cholestatic jaundice

Two cases of Kawasaki disease presented with acute febrile jaundice

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