Abdominal-pain-first presentation of Kawasaki disease

Abstract

Clinicians from Italy cared for a child with high fever and abdominal pain as first complaints of Kawasaki disease. Abdominal computed tomography showed concentric thickening of jejunal bowel, dilatation of small and large intestine, ascitic fluid, and enlargement of mesenteric lymph nodes. As typical mucocutaneous signs and laboratory findings appeared, the diagnosis was considered. IGIV therapy was associated with rapid defervescence and resolution of abdominal pain. The authors reviewed 48 published cases of Kawasaki disease with intestinal involvement. Fever, abdominal pain, and vomiting generally were first or early manifestations, before appearance of mucocutaneous findings. Pseudo-obstruction was present in >80% of cases by plain radiograph or another imaging study. Hydrops of the gallbladder was not common. Kawasaki disease was not an early consideration and 25% of patients underwent surgery. Coronary artery aneurysms were present in 43% of cases at the time of Kawasaki disease diagnosis. Symptoms resolved following IGIV therapy. Authors of published cases did not report intestinal sequelae (but follow up was variable and usually was short). This editor has cared for a very young infant with Kawasaki disease before the IGIV therapy era who had bowel obstruction due to jejunal stenosis 2 months after the acute phase. Compilation of 57 cases of lymph-node-first presentation of Kawasaki disease was reported in The Journal in 2013 (J Pediatr 2013;162:1259-63).1 We now add abdominal-pain-first presentation. It should not be too surprising that intestinal vasculitis could be significant in some cases. Might it not suggest an intestinal portal of microbe or super antigen entry, as might cervical lymphadenitis a respiratory tract portal of entry? The 43% rate of coronary artery aneurysms at the time of diagnosis in cases of abdominal-pain-first Kawasaki disease in the literature likely represents both diagnosis and reporting biases. However, it behooves us all to consider Kawasaki disease in the differential when a child has high fever and abdominal pain. Article page 186 ▶ Intestinal Involvement in Kawasaki DiseaseThe Journal of PediatricsVol. 202PreviewTo describe a case of Kawasaki disease with intestinal involvement and to analyze other published reports to define clinical characteristics, diagnostic issues, and therapeutic approaches of gastrointestinal involvement in Kawasaki disease. Full-Text PDF