Kawasaki Disease and the Pediatric Gastroenterologist: A Diagnostic Challenge

• Published in: Journal of pediatric gastroenterology and nutrition Vol. 56; no. 3; pp. 297 - 299
• Main Authors: Eladawy, Mohammed, Dominguez, Samuel R, Anderson, Marsha S, Glodé, Mary P
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Copyright by ESPGHAN and NASPGHAN 01.03.2013; Lippincott Williams & Wilkins
• Subjects: Abdominal Pain - etiology; Adolescent; Biological and medical sciences; Child; Child, Preschool; Colorado; Diagnosis, Differential; Exanthema - etiology; Feeding. Feeding behavior; Fever - etiology; Fundamental and applied biological sciences. Psychology; Gastroenteritis - etiology; Hospitals, Pediatric; Humans; Male; Medical Records; Medical sciences; Mucocutaneous Lymph Node Syndrome - diagnosis; Mucocutaneous Lymph Node Syndrome - physiopathology; Referral and Consultation; Retrospective Studies; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Colorado; Human; Kawasaki syndrome; Immunopathology; Pediatrics; Liver; Autoimmune disease; Cardiovascular disease; Metabolic diseases; Gastrointestinal; Vascular disease; Vasculitis; Systemic disease; Gastroenterology; Diagnosis; Child; kawasaki disease
• ISSN: 0277-2116; 1536-4801
• DOI: 10.1097/MPG.0b013e3182794432

BACKGROUND AND OBJECTIVES:Gastrointestinal symptoms and signs are rarely the main clinical presentation of Kawasaki disease (KD). In the present study, we report a series of patients with KD in whom a gastroenterology consult was obtained before consideration of the diagnosis of KD. METHODS:We retrospectively reviewed all patients with KD admitted to Childrenʼs Hospital Colorado from January 2009 through February 2011 with prominent gastrointestinal symptoms, resulting in gastrointestinal service consultation before their diagnosis of KD. RESULTS:We identified 7 of 118 (6%) patients with KD who met our criteria. All 7 patients were males, and the median age at admission was 9.7 years. All patients had abdominal pain and fever at presentation. Vomiting, diarrhea, and clinical jaundice were present in 70%, 50%, and 43% of patients, respectively. Aminotransferases and/or γ-glutamyl transpeptidase abnormalities were observed in 6 (89%) patients. All of the patients had fever and rash on admission, and 86% had nonexudative conjunctivitis and 71% had mucosal changes. Median duration of illness at gastroenterology consultation was 5 days, whereas median duration of illness at infectious disease consultation was 6 days. One patient developed coronary artery dilation and 2 patients had intravenous immunoglobulin-resistant KD. CONCLUSIONS:Gastroenterologists should be aware of gastrointestinal presentations of KD. Unexplained gastrointestinal symptoms in the presence of fever, and 1 or 2 of the major clinical signs of KD, should prompt consideration of KD in the differential diagnosis.