Severe Kawasaki disease with muscle weakness and urinary retention: A case report

Abstract

Background Kawasaki disease (KD) is an acute systemic immune vasculitis affecting multiple organs and systems in children, and is prevalent in children under 5 years of age. Myasthenia gravis is a rare manifestation of KD, and only 11 pediatric patients with KD combined with myasthenia gravis have been reported, of which evidence of myasthenia gravis was found in 2/3 of the patients, and 1/3 could not be explained by myasthenia gravis, the mechanism of which is still unclear.Cases of KD combined with urinary retention are even more rare, and there has been only 1 case report of KD combined with urinary retention in a child with no previous underlying disease. Case presentation: We report a 22-month-old Asian child with severe KD who initially presented with fever and muscle weakness in the lower extremities, which progressed to progressive muscle weakness in the extremities, followed by urinary and fecal retention and rapid onset of heart failure, respiratory failure and shock. The child developed coronary artery dilatation without the main clinical features of Kawasaki disease such as rash, conjunctival congestion, desquamation of the extremity endings, orofacial changes and enlarged lymph nodes in the neck. Muscle enzymes and electromyography were normal. Temperature gradually normalized and muscle strength recovered slightly after intravenous immunoglobulin. The child could be helped to walk after 1 week of aspirin combined with prednisone therapy. Conclusions We present the case of a 22-month-old child with severe KD. The child began with progressive muscle weakness in the extremities, followed by urinary and fecal retention, and rapidly developed heart failure, expiratory failure, and shock. Despite early failure to detect the disease, the child recovered rapidly and had a favorable prognosis. KD comorbidities with muscle weakness as the main manifestation are uncommon. This is the first case report of severe Kawasaki disease combined with both muscle weakness and rectal bladder dysfunction, which may provide clinicians with diagnostic and therapeutic ideas, as well as a basis for future exploration of the mechanisms of KD combined with muscle weakness or urinary retention.