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Acute febrile cholestatic jaundice in children: keep in mind Kawasaki disease

Andrea Taddio1, Maria Chiara Pellegrin, Chiara Centenari

  • 1Department of Pediatrics, Institute of Child Health IRCCS Burlo Garofolo, University of Trieste, Trieste, Italy. ataddio@yahoo.it

Journal of Pediatric Gastroenterology and Nutrition
|March 23, 2012
PubMed

Insights

Kawasaki disease (KD) can present with febrile cholestatic jaundice, a condition often mistaken for other causes. Early suspicion of KD is crucial for timely diagnosis and treatment in pediatric patients.

Area of Science:

  • Pediatrics
  • Gastroenterology
  • Infectious Diseases

Background:

  • Kawasaki disease (KD) is a pediatric vasculitis typically presenting with fever and mucocutaneous inflammation.
  • Gastrointestinal symptoms, including cholestatic jaundice, are frequently observed in KD but are not part of the classic diagnostic criteria.
  • Febrile cholestatic jaundice in children can mimic other serious conditions, complicating diagnosis.

Purpose of the Study:

  • To investigate the incidence and significance of Kawasaki disease (KD) as a cause of febrile cholestatic jaundice in pediatric patients.
  • To evaluate the diagnostic challenges and emphasize the importance of considering KD in the differential diagnosis of unexplained febrile cholestatic jaundice.

Main Methods:

  • A retrospective review of pediatric patients admitted with febrile cholestatic jaundice between 2003 and 2010.
  • Data were collected from two tertiary pediatric care centers.
  • Analysis focused on identifying the underlying causes, with a specific look at KD prevalence.

Main Results:

  • Kawasaki disease (KD) was identified as the second most frequent cause of febrile cholestatic jaundice, accounting for 21% of cases.
  • Viral infections were the most common etiology.
  • The findings highlight a significant, often overlooked, association between KD and this clinical presentation.

Conclusions:

  • Febrile cholestatic jaundice is a relevant, albeit atypical, presentation of Kawasaki disease (KD) in children.
  • A high index of suspicion for KD is warranted in pediatric patients presenting with febrile cholestatic jaundice, even in the absence of classic symptoms.
  • Early recognition of KD in this context can lead to prompt management and potentially prevent long-term complications.

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