Acute Jaundice in a Six-year-old: An Unusual Presentation of Atypical Kawasaki Disease

Bylund, Lcdr William; Zarow, Gregory J.; Ponce, Lcdr Daphne Morrison

doi:10.5811/cpcem.2019.12.45180

Cited by 4 publications

(3 citation statements)

References 13 publications

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“… Abbreviations: CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; ALT, alanine aminotransferase; WBC, white blood cell; hpf, high-power field; LAD, left anterior descending artery; RCA, right coronary artery. a If inflammatory markers do not meet threshold for work-up for incomplete Kawasaki disease, serial clinical and laboratory evaluation may be warranted if there is persistent fever. b A positive echocardiogram despite lack of laboratory evidence establishes the diagnosis. c There are reports of unusual manifestations, such as acalculous cholecystitis, obstructive jaundice, and sensorineural hearing loss. 15-17 Note: The diagnostic criteria are from McCrindle et al 8 …”

Section: Discussionmentioning

confidence: 99%

“… c There are reports of unusual manifestations, such as acalculous cholecystitis, obstructive jaundice, and sensorineural hearing loss. 15-17 …”

Section: Discussionmentioning

confidence: 99%

“…ACM was responsible for the literature search and first draft of the There are reports of unusual manifestations, such as acalculous cholecystitis, obstructive jaundice, and sensorineural hearing loss. [15][16][17] Note: The diagnostic criteria are from McCrindle et al 8…”

Section: Author Contributionsmentioning

confidence: 99%

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Color Changes in the Fingers and Toes of an Infant

Murphey

Ponce

Hashikawa

2020

Clin Pediatr (Phila)

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Section: Discussionmentioning

confidence: 99%

“… c There are reports of unusual manifestations, such as acalculous cholecystitis, obstructive jaundice, and sensorineural hearing loss. 15-17 …”

Section: Discussionmentioning

confidence: 99%

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Color Changes in the Fingers and Toes of an Infant

Murphey

Ponce

Hashikawa

2020

Clin Pediatr (Phila)

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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 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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Acute Jaundice in a Six-year-old: An Unusual Presentation of Atypical Kawasaki Disease

Cited by 4 publications

References 13 publications

Color Changes in the Fingers and Toes of an Infant

Color Changes in the Fingers and Toes of an Infant

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

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