Jaundice as an Unusual Presentation of Kawasaki Disease: A Case Report

Ahmad, Tariq; Soltani, Behzad; Rezaei, Mostafa Haji

doi:10.5812/pedinfect.27594

Arch Pediatr Infect Dis

2015

DOI: 10.5812/pedinfect.27594

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Jaundice as an Unusual Presentation of Kawasaki Disease: A Case Report

Tariq Ahmad

Behzad Soltani

Mostafa Haji Rezaei

Abstract: Introduction: Atypical Kawasaki disease (KD) is a diagnostic dilemma. Acute acalculous cholestasis and liver involvement sometimes indicate atypical presentations of KD. Case Presentation: We report a four-year-old boy with fever, abdominal pain, vomiting, jaundice and mild liver enlargement who gradually developed other signs of KD. He was treated by aspirin, intravenous immunoglobulin and finally methylprednisolone pulse therapy with no sequela. Conclusions: KD should be kept in mind as one of the causes of … Show more

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Cited by 3 publications

References 15 publications

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Kawasaki Disease Presenting with Fever and Jaundice: Case Report

Li,

Xue,

Zheng

et al. 2024

Br J Hosp Med

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Kawasaki disease (KD), which is also known as cutaneous mucosal lymph node syndrome, is an acute, self-limiting, necrotizing vasculitis with unclear cause that primarily affects small- and medium-sized blood vessels and most commonly affects children aged 6 months to 5 years. Currently, diagnosis is based primarily on typical clinical symptoms. Approximately 15%–20% of patients are highly suspected of having KD; however, they do not match the diagnostic criteria for typical KD, which is referred to as incomplete Kawasaki disease (IKD), and this has become a major challenge in the diagnosis and treatment of KD. We describe a case of a 7-year-old boy who had a fever and jaundice as his initial symptoms. After a series of clinical laboratory and imaging examinations and marked improvement of symptoms after treatment with intravenous immunoglobulin (IVIG), IKD was considered as the diagnosis. When children present with jaundice and fever, physicians should consider KD as a possible diagnosis to ensure early detection and treatment of the disease.

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Kawasaki Disease Presenting with Fever and Jaundice: Case Report

Li,

Xue,

Zheng

et al. 2024

Br J Hosp Med

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Kawasaki Disease With Combined Cholestatic Hepatitis and Mycoplasma pneumoniae Infection: A Case Report and Literature Review

et al. 2022

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Kawasaki disease (KD), also called mucocutaneous lymph node syndrome, is a febrile multisystem vasculitis mainly affecting children younger than 5 years. KD typically manifests as skin lesions and in the lymph nodes and oral and conjunctival mucosa. It may induce coronary artery abnormalities, such as aneurysms, but gastrointestinal and hepatobiliary involvement are not common. We reviewed 32 cases of patients with a diagnosis of KD with hepatobiliary involvement between 2000 and 2021 and present the case of a 4-year-old girl who received a diagnosis of KD with combined cholestatic hepatitis and Mycoplasma pneumoniae infection. In the 33 cases reviewed, in addition to the classical clinical findings of KD, the most common clinical presentations were jaundice and abdominal pain. Moreover, abnormal laboratory results indicating hyperbilirubinemia, cholestasis, and hepatitis, among other conditions, were noted. Abdominal ultrasonography revealed abnormal findings in more than half children with KD with hepatobiliary involvement. Furthermore, cardiac involvement was noted in a high proportion of the patients. In particular, we noted the case of a 4-year-old girl with a rare presentation of 3-day fever combined with abdominal pain and jaundice. Her levels of aspartate aminotransferase, alanine aminotransferase, total bilirubin, direct bilirubin, alkaline phosphatase, and γ-glutamyl transpeptidase were 489 (15–50) U/L, 253 (5–45) U/L, 4.3 (<1.5) mg/dl, 2.4 (<0.2) mg/dl, 337 (134–315) U/L, and 145 (5–32) U/L, respectively. These results were indicative of cholestatic hepatitis. Furthermore, her serological test results for mycoplasma infection were positive. KD was diagnosed because the patient had high fever for more than 5 days and presented with lymphadenopathy on the left side of neck, a polymorphic skin rash, redness of oral mucosa with strawberry tongue, and nonpurulent conjunctival congestion. After intravenous immunoglobulin injection (IVIG) and acetylsalicylic acid administration, the fever subsided rapidly and clinical manifestations, such as jaundice and abdominal pain, were mitigated. The laboratory parameters gradually returned to within normal ranges. Echocardiography revealed no aneurysm. In conclusion, KD with cholestatic hepatitis should be considered when pediatric patients present with fever combined with abdominal pain and jaundice. Early treatment with IVIG and aspirin is recommended and can effectively relieve cholestatic hepatitis.

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A Systematic Review of Atypical Presentations of Kawasaki Disease

Arjmand,

Soltani,

Yousefi Manesh

et al. 2023

Int J Enteric Pathog

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Background: Kawasaki disease (KD) is a systematic vasculitis that mainly affects children under five years old. Diagnosis is made based on clinical criteria. Objectives: This study aimed to determine various atypical presentations of KD to prevent misdiagnosis. Methods: A comprehensive systematic search in PubMed, Web of Science, and Scopus databases was performed based on the PRISMA guidelines from 2012 to January 2023. Case reports and case series studies reporting the atypical presentations of KD, only in the English language, were included, and the Joanna Briggs Institute (JBI) checklist was utilized for case report studies as a quality assessment tool. Results: Our findings revealed that patients with KD can present with gastrointestinal and hepatobiliary, cardiovascular, mucocutaneous, neurological, musculoskeletal, respiratory, retropharyngeal, and renal complications. Macrophage activation syndrome and normal inflammatory biomarkers were rare manifestations. The most common cause of the patient’s death was cardiovascular manifestations, especially myocardial infarction. Cardiovascular and gastrointestinal involvement were the most prevalent. Conclusion: Focusing on atypical and rare manifestations facilitates the correct diagnosis, leading to timely and appropriate management, improving outcomes, and reducing complications.

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Jaundice as an Unusual Presentation of Kawasaki Disease: A Case Report

Cited by 3 publications

References 15 publications

Kawasaki Disease Presenting with Fever and Jaundice: Case Report

Kawasaki Disease Presenting with Fever and Jaundice: Case Report

Kawasaki Disease With Combined Cholestatic Hepatitis and Mycoplasma pneumoniae Infection: A Case Report and Literature Review

A Systematic Review of Atypical Presentations of Kawasaki Disease

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