Kawasaki disease and hepatobiliary involvement: report of two cases

Keeling, Ingeborg M.; Beran, Elisabeth; Dapunt, O

doi:10.1186/s13052-016-0238-7

Cited by 8 publications

(9 citation statements)

References 12 publications

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“…The natural recovery time of liver function tests in KD has been rarely studied. As summarized in Table 1 , it has been reported only in one series where it appears to be 7 days (median), ranging from 2 days to 99 days [ 6 ], and in one case report where aminotransferases recovered after 4 months from onset [ 7 ]. Another series describes only an early tendency to recovery in the first/second week of illness [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Early recognition of liver function tests abnormalities may help to intercept an IVIG resistant disease, a condition which tends to be more prevalent in those who develop coronary artery abnormalities [ 11 ]. High AST levels and abnormal ultrasonographic biliary findings moreover have been considered risk factors for coronary artery abnormality and/or recurrent KD if they are present during the first episode [ 7 , 10 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Atypically Protracted Course of Liver Involvement in Kawasaki Disease. Case Report and Literature Review

et al. 2021

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Hypertransaminasemia in patients with Kawasaki disease (KD) is reported to be transient. Here, we describe a child with an atypically protracted course of liver tests abnormalities and review the inherent literature. The patient was hospitalized at age 7-months for isolated hypertransaminasemia detected during a classical KD diagnosed 3 months before, and persistent since then. KD clinical evolution had been favorable, with rapid response to acetylsalicylic acid and intravenous immunoglobulins. Liver enzymes however remained persistently elevated with a fluctuating pattern (ALT > AST levels; peak of AST 186 IU/L and ALT 240 IU/L). During follow-up, the main causes of liver dysfunction had to be excluded through appropriate and extensive laboratory investigations. Transaminases values become steadily normal only 7 months after the acute presentation of KD. Conclusions: Our report shows that an atypically protracted courses of KD-related hypertransaminasemia above the previously reported temporal limits should be taken into account during the stepwise diagnostic approach to the patient’s liver dysfunction. Insidious acetylsalycilic acid-hepatotoxicity warrants consideration in the differential diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Atypically Protracted Course of Liver Involvement in Kawasaki Disease. Case Report and Literature Review

et al. 2021

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“…This case and others emphasize the importance for emergency physicians to retain a high level of suspicion for KD when a child presents with febrile or afebrile obstructive jaundice. [7][8][9][10][11][12][13][14][15] Documented patient informed consent and/or Institutional Review Board approval has been obtained and filed for publication of this case report.…”

Section: Discussionmentioning

confidence: 99%

“…We identified nine previous case reports, with a total of 17 KD patients displaying jaundice. [7][8][9][10][11][12][13][14][15] Although rarely reported, KD is the most common cause of glutamyltransferase was elevated at 241U/L (15-73 U/L). Throat cultures, antistreptolysin O, hepatitis B surface antigen, hepatitis B core antibody, hepatitis A immunoglobulin (Ig) M, hepatitis C antibody, cytolomegalo virus IgG/IgM, toxoplasmosis IgG/IgM, monospot, blood cultures, and leptospirosis testing were negative, making infectious or post-infectious etiologies less likely.…”

Section: Image 1 Erythematous Tongue With Papules On Day Of Emergency Department Presentation (Day 4 Of Illness)mentioning

confidence: 99%

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

Bylund

Zarow

Ponce

2020

Clinical Practice and Cases in Emergency Medicine

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Kawasaki disease (KD) is a rare vasculitis of childhood that is critical to recognize and treat due to associated morbidity and mortality. A six-year-old male presented to our emergency department (ED) afebrile but with reported recent fevers. Exam revealed jaundice and erythematous tongue with papules, and laboratory studies indicated a direct hyperbilirubinemia. Admitted for evaluation, he developed continuous fever, increasing maculopapular rash, and subsequent desquamation of hands and feet. He ultimately met criteria for incomplete KD, was treated with intravenous immunoglobulin, and avoided cardiac complications. This presentation of incomplete KD with hyperbilirubinemia is rare because the patient was afebrile at ED presentation.

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“… Bader-Meunier et al [ 17 ] 3.5 + + NR 5 2.5 4 15 23.9 – IVIG 1 g/kg/day. Not refractory Keeling et al [ 18 ] 12 + + + 1.91 0.80 1.43 2.63 48.9 – IVIG 1.6 g/kg/day. Oral Aspirin.…”

Section: Discussionmentioning

confidence: 99%

Hepatic predominant presentation of Kawasaki disease in adolescence case report and review of literature

et al. 2020

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Background Kawasaki Disease (KD) is the most common paediatric vasculitis affecting small to medium arteries. Although the average age of diagnosis is 3.4 years with a well-defined clinical presentation, older patients with KD including adolescent and adult patients demonstrate a less classical presentation with prominent findings including hepatitis, cervical lymphadenopathy, and arthralgia. We describe a case of an adolescent presentation of Kawasaki Disease presenting with a predominantly cholestatic hepatic picture. Case presentation We describe a case of KD in a 16-year-old Caucasian female with predominately hepatic disease that showed resistance to intravenous immunoglobulin (IVIG). The formal diagnosis of KD was made on her 8th day of symptoms. She displayed classical symptoms commencing with fever, followed by peripheral desquamation, strawberry tongue, cervical lymphadenopathy. She became clinically jaundiced with evidence of hepatic artery narrowing on ultrasound that resolved with treatment. Her disease was biphasic and required further IVIG for non-hepatic symptoms. She did not develop coronary aneurysms. Conclusion Significant hepatic dysfunction with clinical jaundice is rare in KD without associated gall bladder hydrops and tends to occur in older patients. We describe such a case and review the five described cases in the literature. Diagnostic delay is more common in adolescent patients and given that the prognosis of KD is closely correlated to diagnostic timing and provision of care, it is important to consider Kawasaki Disease in older demographics especially with undiagnosed hepatic disease.

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Kawasaki disease and hepatobiliary involvement: report of two cases

Cited by 8 publications

References 12 publications

Atypically Protracted Course of Liver Involvement in Kawasaki Disease. Case Report and Literature Review

Atypically Protracted Course of Liver Involvement in Kawasaki Disease. Case Report and Literature Review

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

Hepatic predominant presentation of Kawasaki disease in adolescence case report and review of literature

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