A case of Kawasaki disease presenting as sigmoid colitis

Yasuhiro Ohnishi,Miki Inoue,Mitsuyasu Yano,Nobuo Satake,Kazuhiro Mori

doi:10.1007/s10396-017-0808-3

Yasuhiro Ohnishi, Miki Inoue + Show 3 more

Open Access

https://doi.org/10.1007/s10396-017-0808-3

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Abstract

Initial gastrointestinal symptoms might confuse the clinical pictures of some patients with Kawasaki disease (KD) and delay diagnosis and treatment, especially when the patient does not fulfill sufficient diagnostic criteria for KD. Here, we present the case of a 4-year-old boy with KD who complained of severe left abdominal pain and fever alone for the first 6 days. Abdominal ultrasonography showed severe wall thickening localized to the sigmoid colon, and these findings were confirmed by computed tomography and colonoscopy. Microscopic examination of a biopsy specimen revealed non-specific colitis with inflammatory cells in the lamina propria of the sigmoid colon, indicating sigmoid colitis. He subsequently exhibited typical symptoms of KD and was successfully treated with oral administration of aspirin. We suggest that KD should be considered as a differential diagnosis in any child presenting with abdominal symptoms and prolonged fever without definable cause. Abdominal ultrasonography can help evaluate the gastrointestinal complications of KD.

Highlights

Kawasaki disease (KD) is an acute, systemic febrile vasculitis of unknown etiology
Abdominal ultrasonography showed severe wall thickening localized to the sigmoid colon, and these findings were confirmed by computed tomography and colonoscopy
We suggest that KD should be considered as a differential diagnosis in any child presenting with abdominal symptoms and prolonged fever without definable cause

Summary

Introduction

Kawasaki disease (KD) is an acute, systemic febrile vasculitis of unknown etiology. Gastrointestinal symptoms including diarrhea and vomiting are relatively common findings. Oral antibiotics prescribed by his previous doctor had not proven effective On admission, he had no symptoms other than left lower abdominal pain and fever. Ultrasonography showed significant thickening of the wall localized to the sigmoid colon, predominantly in the submucosal layer (Fig. 1a, b). Contrast-enhanced abdominal CT revealed localized thickening of the bowel wall in the sigmoid colon (Fig. 2). Colonoscopy showed severe circumferential thickening of the bowel wall and slight redness of the mucous membranes localized to the sigmoid colon (Fig. 3a, upper). Based on a tentative diagnosis of sigmoid colon colitis, intravenous administration of antibiotics was tried for 2 days.

Discussion

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