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She X, Chen J, Zhou YN, Guo J, Zhao FH, Yi C. Kawasaki Disease Associated Acute Abdomen: Most Require No Surgery. J Inflamm Res 2023; 16:5157-5162. [PMID: 38026259 PMCID: PMC10644836 DOI: 10.2147/jir.s434982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To summarize the clinical features and treatment experiences of patients with Kawasaki disease (KD)-associated acute abdomen (KD-AA). Methods We conducted a retrospective case-control study of patients with KD-AA treated at our hospital between January 2006 and November 2022. Results Of the 917 children with KD, 43 (4.7%) presented with AA. Of these, 33 with complete information were included in the KD-AA group. Patients with KD-AA were significantly older, with higher neutrophil rate, C-reactive protein, procalcitonin, and alanine transaminase levels and lower hemoglobin, albumin, and serum sodium levels. Additionally, more patients with KD-AA presented with aseptic meningitis and KD shock syndrome than those with KD alone (all p<0.05). The two groups did not differ in the incidence of intravenous immunoglobulin (IVIG) resistance, incomplete KD, or coronary artery abnormalities. All patients received aspirin and IVIG therapy, with nine receiving a second dose of IVIG and 11 receiving corticosteroids. Only two patients with KD-AA underwent surgery, and the prognosis of all patients with KD-AA was good. Conclusion KD-AA should be suspected in febrile children with abdominal symptoms. Prompt diagnosis of KD-AA is important for early effective treatment to avoid unnecessary surgical harm. KD, complicated by acute abdomen, has a good prognosis.
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Affiliation(s)
- Xiang She
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Jia Chen
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Yu-Neng Zhou
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Jun Guo
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Feng-Hua Zhao
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
| | - Cong Yi
- Department of Pediatrics, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, 621000, People’s Republic of China
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Yang P, Mao Z, Sun M, Guo J. Clinical features analysis of Kawasaki disease with abdominal symptoms as the first manifestation. Eur J Pediatr 2023; 182:4049-4057. [PMID: 37394531 DOI: 10.1007/s00431-023-05086-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/08/2023] [Accepted: 06/24/2023] [Indexed: 07/04/2023]
Abstract
To investigate the clinical characteristics of Kawasaki disease (KD) presenting with abdominal manifestation as the first manifestation. Our findings may help improve the cognition of KD with abdominal complications, and avoid misdiagnosis and missed diagnosis. A retrospective analysis was conducted of 1490 KD patients admitted to Shengjing Hospital between January 2019 and March 2022. Clinical characteristics, related factors, and prognosis of KD with abdominal manifestation as first manifestation were analyzed. Based on the presenting symptoms, patients were divided into gastrointestinal symptom group (n = 141), liver dysfunction group (n = 55), and control group (n = 1294). In the gastrointestinal group, diarrhea [100 cases (70.9%)], vomiting [55 cases (39.0%)], and abdominal pain [34 cases (24.1%)] were the most common symptoms at onset. 8 cases (5.7%) were complicated with pseudo-intestinal obstruction, 6 cases (4.3%) with ischemic colitis, 5 cases (3.5%) with pancreatitis, 2 cases (1.4%) with appendicitis, and 1 case (0.7%) with cholecystitis. Comparied to ordinary gastroenteritis caused by infection, gastroenteritis with KD has longer fever duration before treatment, higher WBC, PLT, CRP, AST levels and lower albumin levels. All patients in the liver dysfunction group had elevated transaminases, and 19 patients (34.5%) presented with jaundice. In the gastrointestinal group, the average hospital stay was 10.3 days, and the incidence of IVIG unresponsiveness and coronary artery lesion were 18.4% and 19.9%, respectively, which were significantly higher than that in the control group. In the liver dysfunction group, the average hospital stay (11.18 days), incidence of IVIG unresponsiveness (25.5%), and incidence of coronary artery lesion (29.1%) were significantly higher than that in the control group. On multivariate logistic regression analysis, gastrointestinal involvement, fever duration, ALT, PLT, and CRP were identified as risk factors for CAL, younger age, gastrointestinal involvement and fever duration were risk factors for IVIG unresponsiveness. Conclusion: KD with gastrointestinal involvement is associated with a higher risk of IVIG unresponsiveness and coronary artery lesion. KD should be considered in the differential diagnosis of children with acute fever, especially those with gastrointestinal involvement and liver dysfunction. What is Known: • Fever duration, PLT, and CRP were identified as risk factors for CAL. Timely diagnosis and application of IVIG treatment can avoid exploratory laparotomy for ileus, appendectomy for misdiagnosed appendicitis, colonoscopy for misdiagnosed inflammatory bowel disease, and reduce the complications of CAL and IVIG unresponsiveness. What is New: • Abdominal symptoms as the first manifestation can be an independent risk factor for CAL and IVIG unresponsiveness. KD should be considered in the differential diagnosis of children with acute fever, especially those with gastrointestinal symptoms or liver dysfunction. • Gastroenteritis in KD group had longer fever duration before treatment, accompanied with higher WBC, PLT, CRP, AST levels and lower albumin levels than those gastroenteritis caused by infection. Therefore, high attention should be paid to the possibility of KD when gastroenteritis accompanied by along fever duration, high WBC, PLT, CRP, AST level or lowalbumin level.
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Affiliation(s)
- Pingping Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Zhiqin Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Mei Sun
- Department of Pediatrics, Shengjing Hospital of China Medical University 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Jing Guo
- Department of Pediatrics, Shengjing Hospital of China Medical University 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China.
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Fujita Y, Yamaguchi T, Kurosaki K, Matsudera S, Watanabe S, Takayanagi F, Suzuki K, Yoshihara S. Kawasaki Disease Preceded by Acute Appendicitis: A Pediatric Case. Indian J Pediatr 2023; 90:100. [PMID: 36434493 DOI: 10.1007/s12098-022-04408-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
| | - Takeshi Yamaguchi
- Divison of Pediatric Surgery, Surgical Oncology Graduate School of Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Kazunori Kurosaki
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Shotaro Matsudera
- Divison of Pediatric Surgery, Surgical Oncology Graduate School of Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Shun Watanabe
- Divison of Pediatric Surgery, Surgical Oncology Graduate School of Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Fumitaka Takayanagi
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Kan Suzuki
- Divison of Pediatric Surgery, Surgical Oncology Graduate School of Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
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Yi C, She X, Chen J. Kawasaki disease complicated with shock syndrome, macrophage activation syndrome, and acute abdomen in children: Two case reports. Front Pediatr 2023; 11:1152242. [PMID: 37152308 PMCID: PMC10160470 DOI: 10.3389/fped.2023.1152242] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Background Kawasaki disease (KD) is an acute systemic vasculitis that can involve multiple organs. Few reports have been published about KD patients presenting with multiple complications such as acute abdomen, KD shock syndrome (KDSS), and macrophage activation syndrome (MAS). Case Description We present the cases of two males (9 and 12 years old) diagnosed with KD accompanied by rare manifestations. Case 1 is a 9-year-old male treated for acute appendicitis, KDSS, and MAS. Case 2 is a 12-year-old male who presented with KDSS, MAS, and an ileal perforation. They were treated with intravenous immunoglobulin, aspirin, high-dose corticosteroids, vasoactive drugs, and symptomatic treatment, with good outcomes. Conclusions Clinicians should be aware of the possibility of KD in the presence of fever and unusual manifestations, such as severe inflammatory indicators and acute abdomen that is nonresponsive to antibiotic therapy. Meanwhile, KD-related unusual complications should be recognized, such as KDSS and MAS.
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Affiliation(s)
| | | | - Jia Chen
- Correspondence: Jia Chen Xiang She
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Huang YN, Liu LH, Chen JJ, Tai YL, Duh YC, Lin CY. Appendicitis as a Leading Manifestation of Kawasaki Disease in Older Children. CHILDREN 2022; 9:children9020193. [PMID: 35204914 PMCID: PMC8870670 DOI: 10.3390/children9020193] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
Kawasaki disease (KD) is a systematic inflammatory disease with multiple organ involvement. Timely diagnosis and prompt management are essential for successful treatment. KD, with an atypical presentation, remains a diagnostic challenge for physicians. We report a five-year-old boy who presented with appendicitis. An appendectomy was performed; however, his fever persisted. The boy was diagnosed with KD and intravenous immunoglobulin was administered. His symptoms resolved, and he had an uneventful recovery. Furthermore, we performed a literature review with 13 cases identified in the literature. Most cases were male, and the average age was older than typical for KD. In conclusion, KD may present with abdominal complaints and appendicitis may be a rare initial presentation of KD. Multidisciplinary cooperation and high awareness are warranted for timely diagnosis, especially in older children experiencing persistent fever after an appendectomy.
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Affiliation(s)
- Ya-Ning Huang
- Department of Pediatrics, MacKay Children’s Hospital, Taipei 10449, Taiwan;
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan; (L.-H.L.); (J.-J.C.); (Y.-L.T.)
| | - Lu-Hang Liu
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan; (L.-H.L.); (J.-J.C.); (Y.-L.T.)
| | - Jeng-Jung Chen
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan; (L.-H.L.); (J.-J.C.); (Y.-L.T.)
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu City 30071, Taiwan
| | - Yu-Lin Tai
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan; (L.-H.L.); (J.-J.C.); (Y.-L.T.)
| | - Yih-Cherng Duh
- Division of Pediatric Surgery, Department of Surgery, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, New Taipei City 25245, Taiwan
- Correspondence: (Y.-C.D.); (C.-Y.L.)
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu City 30071, Taiwan; (L.-H.L.); (J.-J.C.); (Y.-L.T.)
- Department of Medicine, MacKay Medical College, New Taipei City 25160, Taiwan
- Correspondence: (Y.-C.D.); (C.-Y.L.)
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Kuroda K, Stottlemyre M. Acute Appendicitis Associated With Kawasaki Disease: Case Report and Review of the Literature. Cureus 2021; 13:e18997. [PMID: 34853740 PMCID: PMC8608400 DOI: 10.7759/cureus.18997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 12/12/2022] Open
Abstract
Acute appendicitis is a rare complication of Kawasaki disease in the setting of the absence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We experienced a rare case of acute appendicitis associated with Kawasaki disease. The patient is a six-year-old male who was brought to the emergency department by his mother with a pruritic rash, nausea, vomiting, and abdominal pain. Given fever, tenderness in the right lower quadrant on physical examination, leukocytosis with bandemia, and a non-compressible and dilated appendix on ultrasound, he was diagnosed with acute appendicitis and was treated with a laparoscopic appendectomy. He developed persistent fevers after surgery with new lip swelling, mucositis, and bilateral conjunctival injection. Kawasaki disease was suspected and intravenous gammaglobulin and aspirin were administrated. He made a full recovery. This case suggests that careful examination is needed for accurate diagnosis, especially in patients with postoperative persistent fever without signs of intra-abdominal complications. We performed a PubMed literature search and reviewed eight cases of appendicitis associated with Kawasaki disease. Of note, this case was seen in 2018 before the SARS-CoV-2 pandemic and the description of multisystem inflammatory syndrome in children (MIS-C).
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Affiliation(s)
- Kaku Kuroda
- Family Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, USA.,Pediatrics, United States Naval Hospital Okinawa, Ginowan, JPN
| | - Morgan Stottlemyre
- Pediatrics, Washington University School of Medicine, St. Louis, USA.,Pediatrics, United States Naval Hospital Okinawa, Ginowan, JPN
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