Cholestatic hepatitis as a form of presentation of atypical Kawasaki disease: a case report.
Article Sidebar
Main Article Content
Abstract
Kawasaki disease (KD) is an acute, self-limiting febrile illness and is the leading cause of paediatric acquired heart disease in developed countries. It presents with fever greater than five days, oral mucosal changes, lymphadenopathy, rash, limb involvement and/or conjunctival injection. Liver involvement may range from mildly increased transaminases to severe cholestatic hepatitis and/or vesicular hydrops.
We present a 5-year-old female patient whose symptoms began with acute febrile cholestatic hepatitis, with no apparent cause. On the 14th day of evolution, she added non-purulent conjunctival injection, periungual desquamation and thrombocytosis. In view of the suspicion of atypical KD, an echocardiogram was performed, which revealed coronary involvement. It is important to take into account the variability of symptoms in KD, as the rapid establishment of appropriate treatment reduces the appearance and severity of associated complications.
Downloads
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
How to Cite
References
McCrindle BW, Rowley AH, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017;135(17):e927-e999. https://doi.org/10.1161/CIR.0000000000000484. Errata en: Circulation. 2019;140(5):e181-e184. https://doi.org/10.1161/CIR.0000000000000703. DOI: https://doi.org/10.1161/CIR.0000000000000703
Kawasaki T. [Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children]. Arerugi. 1967;16(3):178-222.
Elakabawi K, Lin J, Jiao F, et al. Kawasaki disease: global burden and genetic background. Cardiol Res. 2020;11(1):9-14. https://doi.org/10.14740/cr993. DOI: https://doi.org/10.14740/cr993
Liang CD, Kuo HC, Yang KD, et al. Coronary artery fistula associated with Kawasaki disease. Am Heart J. 2009;157(3):584-588. https://doi.org/10.1016/j.ahj.2008.11.020. DOI: https://doi.org/10.1016/j.ahj.2008.11.020
Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110(17):2747-2771. https://doi.org/10.1161/01.CIR.0000145143.19711.78. DOI: https://doi.org/10.1161/01.CIR.0000145143.19711.78
Eladawy M, Dominguez SR, Anderson MS, et al. Abnormal liver panel in acute kawasaki disease. Pediatr Infect Dis J. 2011;30(2):141-144. https://doi.org/10.1097/INF.0b013e3181f6fe2a. DOI: https://doi.org/10.1097/INF.0b013e3181f6fe2a
Pratap K, Gardner LS, Gillis D, et al. Hepatic predominant presentation of Kawasaki disease in adolescence case report and review of literature. BMC Gastroenterol. 2020;20(1):352. https://doi.org/10.1186/s12876-020-01461-2. DOI: https://doi.org/10.1186/s12876-020-01461-2
Centenari C, Caprai S, Vitucci P, et al. Hepatic presentation of Kawasaki disease [abstract]. Dig Liver Dis. 2008;40(10):A104-A105. https://doi.org/10.1016/j.dld.2008.07.287. DOI: https://doi.org/10.1016/j.dld.2008.07.287
Ibáñez-Alcalde M, Sánchez-Forte M, Giménez-Sánchez F, et al. Cholestasis as the initial feature of Kawasaki disease. Pediatr Infect Dis J. 2012;31(7):766-767. https://doi.org/10.1097/INF.0b013e318253a1d8. DOI: https://doi.org/10.1097/INF.0b013e318253a1d8
Sociedad Argentina de Pediatría, Sociedad Argentina de Cardiología. Enfermedad de Kawasaki: consenso interdisciplinario e intersociedades (guía práctica clínica). Versión abreviada. Arch Argent Pediatr. 2016;114(4):385-390. https://doi.org/10.5546/aap.2016.385. DOI: https://doi.org/10.5546/aap.2016.385
Dimitriades VR, Brown AG, Gedalia A. Kawasaki disease: pathophysiology, clinical manifestations, and management. Curr Rheumatol Rep. 2014;16(6):423. https://doi.org/10.1007/s11926-014-0423-x. DOI: https://doi.org/10.1007/s11926-014-0423-x
Koca T, Aslan N, Akaslan Kara A, et al. Kawasaki disease in a 9-year old girl presenting with febrile cholestasis: case report and review of literature. Int J Rheum Dis. 2018;21(11):2046-2049. https://doi.org/10.1111/1756-185X.12700. DOI: https://doi.org/10.1111/1756-185X.12700
Falcini F, Resti M, Azzari C, et al. Acute febrile cholestasis as an inaugural manifestation of Kawasaki's disease. Clin Exp Rheumatol. 2000;18(6):779-780.
Göknar N, Doğan Demir A, Ataman Y, et al. A case of Kawasaki disease with initial presentation of arthritis and icterus. Bezmialem Sci. 2017;5(2):86-89. https://doi.org/1 0.14235/bs.2016.939. DOI: https://doi.org/10.14235/bs.2016.939
Vainstein E, Baleani S, Fleiderman S, et al. Ictericia colestática en la enfermedad de Kawasaki. Rev Hosp Niños B.Aires. 2005;47(215):300-305.
Hartas GA, Hashmi SS, Pham-Peyton C, et al. Immunoglobulin resistance in Kawasaki disease. Pediatr Allergy Immunol Pulmonol. 2015;28(1):13-19. https://doi.org/10.1089/ped.2014.0423. DOI: https://doi.org/10.1089/ped.2014.0423