Gallbladder hydrops: when the clinical signs lead to the diagnosis of Kawasaki disease

Cecilia Lugarà, Mariella Valenzise, Fabio Toscano, Melania Amato, Carlo Maria Cassone, Davide Fabio, Agata Vitale, Malgorzata Wasniewska, Giuseppina Zirilli

Abstract


Kawasaki disease (KD) is a vasculitis of the middle and little caliber arteries that specifically affects the coronary arteries. It represents the main cause of acquired cardiopathy in the pediatric population of western countries and in 25% of cases it leads to coronary artery aneurism (1). Atypical KD is nowadays considered a challenge for pediatrics, due to all of its possible clinical manifestations: it is characterized by a long-lasting fever (5 or more days) associated with some of the typical signs and symptoms and other unusual clinical manifestations (as neurological, nephrological, respiratory, gastrointestinal, rheumatological manifestations), variably associated with coronary arteries aneurism. Early diagnosis and treatment are essential to reduce the risk of coronary artery aneurysms (2,3).


We report the case of a 5-year-old boy who came to our attention for skin rash, abdominal pain, increased liver enzymes, and hydrops of the gallbladder. He presented a fever for less than 5 days. 2 weeks later, the appearance of peeling on the fingers and the toes confirmed the diagnosis of an atypical, incomplete KD.

Keywords


Kawasaki syndrome, gallbladder hydrops, hypertransaminasemia

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References


1. Marchesi, A., Tarissi de Jacobis, I., Rigante, D., et al.(2018). Kawasaki disease: guidelines of the Italian Society of Pediatrics, part I - Definition, epidemiology, etiopathogenesis, clinical expression and management of the acute phase. Ital J Pediatr. 44(1):102.doi: 10.1186/s13052-018-0536-3.

2. Marchesi, A., Tarissi de Jacobis, I., Rigante, D., et al.(2018). Kawasaki disease: guidelines of Italian Society of Pediatrics, part II - treatment of resistant forms and cardiovascular complications, follow-up, lifestyle and prevention of cardiovascular risks. Ital J Pediatr. 44(1):103.doi: 10.1186/s13052-018-0529-2.3. 3. McCrindle, B.W., Rowley, A.H., Newburger, J.W., et al. (2019). Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals from the American Heart Association. Circulation. 140(5):e181-e184. doi: 10.1161/CIR.0000000000000484.

4. Rife, E., Gedalia, A. (2020). Kawasaki Disease: an Update. CurrRheumatol Rep. 22(10):75. doi: 10.1007/s11926-020-00941-4.

5. Li, T., Feng, J., Li, N., Liu, T. (2021) Correct identification of incomplete Kawasaki disease. J Int Med Res. 49(3):3000605211001712. doi: 10.1177/03000605211001712.

6. Gorelik, M., Chung, S.A., Ardalan, K., et al. (2022). 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Kawasaki Disease. Arthritis Rheumatol. 74(4):586-596. doi: 10.1002/art.42041.

7. Mossberg, M., Mohammad, A.J., Kahn, F., et al. (2021). High risk of coronary artery aneurysm in Kawasaki disease. Rheumatology (Oxford). 60(4):1910-1914. doi: 10.1093/rheumatology/keaa512.

8. Scherler, L., Haas, N.A., Tengler, A., et al. (2022). Acute phase of Kawasaki disease: a review of national guideline recommendations. Eur J Pediatr. 181(7):2563-2573. doi: 10.1007/s00431-022-04458-z

9. Scherler, L., Haas, N.A., Tengler, A., et al. (2022). Acute phase of Kawasaki disease: a review of national guideline recommendations. Eur J Pediatr. 181(7):2563-2573. doi: 10.1007/s00431-022-04458-z.

10. Mandato, C.,Tripodi, M., Vajro, P. (2015) Approccio diagnostico al bambino con ipertransaminasemia. Qaudreni acp 2015; Volume. 22, N. 5, Pag. 214-221.

11. Poddighe, D., Sazonov, V. (2018) Acute acalculous cholecystitis in children. World J Gastroenterol. 24(43):4870-4879. doi: 10.3748/wjg.v24.i43.4870.




DOI: https://doi.org/10.13129/1828-6550/APMB.111.2.2023.CCS3

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