Cholestasis as the Initial Feature of Kawasaki Disease

Ibáñez-Alcalde, Mercedes; Sánchez-Forte, Miguel; Giménez-Sánchez, Francisco; Ortega-Montes, Ángeles; Martínez-Espinosa, Gema

doi:10.1097/inf.0b013e318253a1d8

Cited by 11 publications

(12 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In case reports, enlarged liver, gallbladder wall thickening with pericholecystic fluid and trace ascites are reported as ultrasonographic findings . However, in some cases that presented with cholestasis, none had abnormalities in the liver, gallbladder and intrahepatic or extrahepatic bile ducts as shown by abdominal ultrasonography …”

Section: Discussionmentioning

confidence: 99%

Kawasaki disease in a 9‐year old girl presenting with febrile cholestasis: case report and review of literature

et al. 2015

View full text Add to dashboard Cite

Kawasaki disease is a systemic vasculitis that develops during childhood, especially in those younger than 5 years. Gastrointestinal involvement does not belong to the classic diagnostic criteria. We reported here, a 9-year old girl who presented with febrile cholestasis, and developed a medium right coronary artery aneurysm despite intravenous immunoglobulin administration on the 9th day of fever. Hepatobiliary ultrasonographic evaluation revealed normal findings. Seroimmunologic markers of cholestasis were negative. Her clinical feature was ameliorated shortly after a second dose of intravenous immunoglobulin administration. We consider that a high index of suspicion of Kawasaki disease could prevent delayed diagnosis and complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Kawasaki disease in a 9‐year old girl presenting with febrile cholestasis: case report and review of literature

et al. 2015

View full text Add to dashboard Cite

show abstract

“…2,6 Another theory behind the cause of shock in these patients is that the vasculitis itself contributes to capillary fragility leading to increased vascular leakage and a distributive shock. 8 Another interesting aspect of this case is the finding of bilateral uveitis with papilledema. 1,3,4,7 In addition, patients with KDSS have been found to have higher rates of cardiac involvement.…”

Section: Discussionmentioning

confidence: 82%

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

Farley

Hodo

2014

Clin Pediatr (Phila)

View full text Add to dashboard Cite

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.

show abstract

“…Hepatobiliary involvement is uncommon in Kawasaki disease, but it is usually described as obstructive jaundice [ 20 ]. Abnormalities of liver panel have been documented in 30–45% of cases [ 10 , 18 , 19 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The mechanism of painful jaundice that occurred in our patient could be related to a distention of the gallbladder, but it spontaneously resolved at the time of ultrasound examination. A vasculitic process in the gallbladder could be supposed to be the cause of an inflammation of the serosa and of obstruction [ 20 ]. Abdominal CT in our patient showed enlarged lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Acute cholestasis as uncommon onset of Kawasaki disease: a case report

Gallerani¹,

Pala

Fabbian

et al. 2020

BMC Gastroenterol

View full text Add to dashboard Cite

Background Kawasaki disease (KD) or mucocutaneous lymph node syndrome is a vasculitis that mostly occurs in young children. Adult-onset KD (AKD) is rare and often misdiagnosed. Here we report a rare case of KD with cholestasis as principal symptom. Case presentation A 43-year-old caucasian man was admitted to our hospital for high fever, lack of appetite related to nausea and vomiting, headache and significant malaise. Physical examination highlighted fever, increasing jaundice, bilateral laterocervical lymph nodes, erythema of the palms, and strikingly red lips and conjunctiva. The clinical course was complicated by arterial hypotension, tachycardia, decreasing haemoglobin, increasing acute phase reactants tests, and multiorgan failure. Due to cardiovascular instability the patient was admitted to the local Intensive Care Unit. Chest X-ray, abdominal ultrasound, chest and abdominal CT and Colangio Magnetic Resonance were normal. Jaundice was investigated and infections, autoimmune diseases or drugs adverse reactions, were excluded. Also coronary artery computed tomography was carried out excluding coronary artery aneurysms. Broad-spectrum antibiotics were not effective. After exclusion other possible conditions, diagnosis of KD was set. He was treated with high doses of corticosteroids and acetylsalicylic acid and clinical conditions as well as laboratory exams improved. Conclusions This report dealing with an adult onset of atypical KD may be of benefit to physicians of various specialties, including primary care doctors, hospital internists, intensivists and gastroenterologists due to its peculiarities. It demonstrates that a case of prolonged fever unresponsive to antibiotics and related to cholestatic jaundice, oedema or erythema of the extremity associated with desquamation of feet and hands, and red eyes, may suggest atypical form of KD.

show abstract

Cholestasis as the Initial Feature of Kawasaki Disease

Cited by 11 publications

References 10 publications

Kawasaki disease in a 9‐year old girl presenting with febrile cholestasis: case report and review of literature

Kawasaki disease in a 9‐year old girl presenting with febrile cholestasis: case report and review of literature

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

Acute cholestasis as uncommon onset of Kawasaki disease: a case report

Contact Info

Product

Resources

About