An 8-Year-Old Male With 4 Days of Fever, Abdominal Pain, and Jaundice

Abstract

An 8-year-old boy with a history of asthma presented to our emergency department with 4 days of fever and abdominal pain. He had been seen by his pediatrician 4 days prior where a rapid strep was negative and he was diagnosed with acute otitis media and started on cefdinir. However, he continued to have malaise, daily fevers, sore throat, and stiff neck. In addition, he had nonbilious, nonbloody emesis and diffuse abdominal pain with minimal appetite and decreased urine output. A macular rash started 4 days prior on his trunk and quickly spread to his face and extremities. His hands and feet were initially red, which had resolved.In the emergency department he had bilateral conjunctivitis and scleral icterus. He was lethargic with dry mucous membranes and a beefy red tongue. In addition, he had bilateral cervical lymphadenopathy. Because of lethargy, tachycardia, and borderline blood pressures, he was given 40 mL/kg saline bolus in the emergency department and admitted to the pediatric intensive care unit for careful monitoring. He was also given a dose of ceftriaxone prior to transfer.Laboratory evaluation demonstrated mild hyponatremia, total bilirubin of 9.2 (primarily conjugated), alanine aminotransferase and aspartate aminotransferase were 85 and 45, respectively, albumin was 3.2, and γ-glutamyl transpeptidase was 258. He also had an elevated blood urea nitrogen of 43 and creatinine 2.85. Complete blood count was obtained with a white blood cell count of 12.4 with 33% bands, hematocrit of 40.9 and platelets of 214 000. A lumbar puncture was obtained with mild cerebrospinal fluid pleocytosis (white blood cells 19 with 1% bands, 16% neutrophils, 29% monocytes, and 54% lymphocytes, red blood cells 7). Inflammatory markers were elevated with a C-reactive protein of 19.5 and erythrocyte sedimentation rate of 45 mm/h.

Kawasaki disease shock syndrome: Unique and severe subtype of Kawasaki disease

“…The most frequent diagnosis at the time of admission was TSS or septic shock. Twenty patients were diagnosed with TSS, 16 of whom had coronary artery abnormalities . Other common diagnoses were suppurative lymphadenitis and myocarditis.…”

“…Twenty patients were diagnosed with TSS, 16 of whom had coronary artery abnormalities. 5,7,9,17,[19][20][21][22][23]26,33,34,39 Other common diagnoses were suppurative lymphadenitis and myocarditis. Seventy-two patients had complete KD (69.9%), and 31 had incomplete KD (31.1%).…”

“…Two hundred and fifty‐three articles on fatal KD, 154 on refractory KD and 254 on shock and KD were analyzed; only those studies that contained detailed case information and fulfilled the case definition of KDSS were included. A total of 91 cases from 41 studies fulfilled the criteria . A total of 103 cases of KDSS were reported in 16 different countries.…”