Hepatobiliary Involvement in Kawasaki Disease 870

Kumar, Mudra Kohli

doi:10.1203/00006450-199804001-00891

Cited by 1 publication

(3 citation statements)

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“…The present study, which aimed to update the epidemiology of GBE associated with KD, found that the complication rate and absence of cholecystitis were identical to the findings of previous reports, 3,7,13 but that the peak occurred at the start of treatment rather than around day 10 of illness as previously reported. Earlier studies on the epidemiology of GBE were performed in the 1980s, 6,7 when IVIG therapy was not widespread. This suggests that the peak of GBE occurrence is now earlier because of enhanced treatments, such as single-dose IVIG and combination therapy with steroids, for patients predicted to be unresponsive to IVIG.…”

Section: Discussionsupporting

confidence: 89%

“…GBE is included as one of the minor criteria in the Japanese KD diagnosis guidelines, 2 which are helpful for diagnosing incomplete KD. Several studies reported that GBE occurred in about 8%–35% of patients with KD 3–5 (more often in male patients), and peaked at around day 10 of illness before resolving spontaneously 6,7 …”

Section: Introductionmentioning

confidence: 99%

“…Several studies reported that GBE occurred in about 8%-35% of patients with KD [3][4][5] (more often in male patients), and peaked at around day 10 of illness before resolving spontaneously. 6,7 Although GBE is highly specific to the acute phase of KD, epidemiological data on GBE have not been updated. Also, the relationship between GBE and cholestasis remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Clinical implications of gallbladder enlargement in Kawasaki disease

Miyazawa

Matsushima

Sakakibara

et al. 2023

Pediatrics International

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BackgroundKawasaki disease (KD) presents with gallbladder enlargement (GBE) or hydrops in the acute phase. Although GBE is highly specific to KD, epidemiological data on GBE have not been updated. In this study we evaluated the occurrence rate of GBE in KD and characterized the clinical features of patients who developed GBE.MethodsThe present study was a prospective, observational study. The maximum longitudinal area of the gallbladder and the common bile duct diameter in KD patients were measured by ultrasonography at the start of initial intravenous immunoglobulin (IVIG) therapy (day 0) and on days 7, 30, and 60 of therapy. The primary outcome was the complication rate of GBE (z‐ score ≥2.0) on day 0. The secondary outcome was the association of GBE with cholestasis, unresponsiveness to IVIG, and coronary artery lesions (CAL).ResultsGallbladder enlargement occurred in 35% (35/101) of patients on day 0. Cholestasis and severe patients (Kobayashi score [KS] ≥5) were more common in the GBE group (20.6% vs. 1.6%, p = 0.002, and 54.3% vs. 15.2%, p < 0.001, respectively). In patients with a KS of ≤4, the non‐responder rate was higher in the GBE group (44% vs. 20%, p = 0.0495) but did not differ in those with a KS of ≥5 (21% vs. 20%, p = 0.95). The rate of CAL occurrence did not differ significantly between the groups (8.6% vs. 6.1%, p = 0.64).ConclusionsGallbladder enlargement occurred in 35% of KD patients and was associated with cholestasis. Gallbladder enlargement may not only be a diagnostic finding, but also a severity marker in KD patients.

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