A case report of atypical Kawasaki disease presented with severe elevated transaminases and literature review

• Published in: BMC infectious diseases Vol. 21; no. 1; p. 415
• Main Authors: Ren, Yifan, Zhang, Chuanxin, Xu, Xiaoqin, Yin, Yu
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04.05.2021; BioMed Central; BMC
• Subjects: Abnormalities; Aminotransferases; Aneurysms; Antibiotics; Atypical Kawasaki disease; Bacterial infections; Blood; C-reactive protein; Cardiovascular diseases; Case Report; Case reports; Case studies; Children; Children & youth; Coronary artery; Coronary artery disease; Coronary vessels; Cytokines; Cytomegalovirus; Developed countries; Diagnosis; Diseases; Echocardiography; Epstein-Barr virus; Family medical history; Fever; Health aspects; Health services; Heart diseases; Hemoglobin; Hepatitis; Hospitalization; Immunoglobulins; Infarction; Infections; Infectious diseases; Intravenous administration; Ischemia; Kawasaki disease; Laboratories; Literature reviews; Liver; Mucocutaneous lymph node syndrome; Myocardial ischemia; Neutrophils; Patients; Pediatric research; Proteins; Severely elevated transaminases; Signs and symptoms; Transaminase; Transaminases; Tumor necrosis factor-TNF; Ultrasonic imaging; Veins & arteries; Viral infections; China; Severely elevated transaminases; Case report; Kawasaki disease; Children; Atypical Kawasaki disease
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-021-06101-y

Kawasaki disease (KD) is the most common cause of acquired heart disease among children in developed countries, in which the resulting coronary artery (CA) abnormalities cause myocardial ischemia, infarction, and death. Prompt diagnosis was essential, and supplemental information should be used to assist the diagnosis when classical clinical criteria are incomplete. The elevated levels of serum transaminases in most KD patients are mild. Herein, a case of atypical KD child with severely elevated transaminase was reported. A child with clinical manifestations of fever, high C-reactive protein (CRP) and severely elevated transaminases was reported. The treatment effect of antibiotic and liver-protecting drugs was not satisfactory. A bilateral diffuse dilation of the CA was detected on echocardiography on day 5 of the illness; thus, atypical KD was diagnosed. Elevated transaminases declined rapidly to normal after the treatment of intravenous immunoglobulin (IVIG). A 1-month follow-up revealed that CA returned to normal, and 2-month, 6-months, and 1-year follow-up revealed the child was in good general health. This case highlighted that atypical KD clinical symptoms were diverse, and severely elevated transaminases might provide a clue to healthcare providers for the diagnosis and management of atypical KD.