<p>Unusual Presentation Of Kawasaki Disease With Gastrointestinal And Renal Manifestations</p>

Abstract

Diagnosis of Kawasaki disease (KD) is based on well-established clinical criteria. In incomplete or atypical KD, the diagnosis is challenging, because of the paucity of clinical signs or because of the presence of clinical manifestations that generally are not seen in KD. We describe the case of a 3-year-old female patient with persistent high fever, vomiting, watery diarrhea, metabolic acidosis and severe hypopotassemia. On the fourth day of fever, bilateral conjunctivitis, mucous and extremity changes were registered. Urine changes as glycosuria and proteinuria were also noticed. Echocardiography revealed ectasia of the left anterior descending coronary artery, and diagnosis of KD was established. The treatment consisted of intravenous immunoglobulin (IVIG) and oral aspirin. Recurrence of disease was recorded on the 23rd day of the disease, with favorable evolution after the second dose of IVIG was infused.

Clinical Manifestations and Laboratory Findings of Kawasaki Disease: Beyond the Classic Diagnostic Features

“…Patients with KD may develop proteinuria, microscopic hematuria, sterile pyuria, and glycosuria during the acute phase of KD [116,117], with pyuria being the most common feature [72]. 28% of KD patients below two years old had developed acute kidney injury (AKI) with their serum creatinine level raised more than two-fold the normal upper limit [118].…”

An Update on Reports of Atypical Presentations of Kawasaki Disease and the Recognition of IVIG Non-Responder Children

“…All results have been tabulated and analyzed in Table 1 and Table 2 . The first one reports on the general data and canonical KD manifestations found in such case reports with atypical KD; the second one details the non-canonical manifestations which were observed in these same patients, challenging the proper diagnosis of KD [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73…”

“…Renal involvement includes interstitial nephritis, hemolytic uremic syndrome, immune complex-mediated nephropathy, and acute nephritic syndrome. Nephrotic syndrome is rarely found as KD atypical manifestation, but the most frequently found innocent renal sign of KD is sterile pyuria, reported in up to 80% of cases [ 41 , 42 , 43 ].…”

Difference in serum miRNA expression between immunoglobulin‑sensitive and ‑insensitive incomplete Kawasaki disease patients

“…Kawasaki disease (KD) is an acute febrile rash disease in children, which is a type of non-specific vasculitis. The main cause of the disease is systemic inflammatory response ( 1 ). Arteries, veins and capillaries may be involved.…”