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Gastrointestinal hemorrhage before anticoagulant therapy in Kawasaki disease: a case report
1Department of Pediatrics, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China.
Insights
Kawasaki disease (KD), a vasculitis causing acquired heart disease in children, can present with rare gastrointestinal bleeding. Early diagnosis is crucial, especially when abdominal symptoms precede characteristic KD signs.
Area of Science:
- Pediatric Rheumatology
- Pediatric Cardiology
- Pediatric Gastroenterology
Background:
- Kawasaki disease (KD) is a leading cause of acquired heart disease in children, characterized by acute febrile multisystem vasculitis.
- KD's systemic nature can mimic other conditions, potentially delaying diagnosis, particularly when gastrointestinal symptoms are prominent.
- While gastrointestinal issues are common in KD, significant gastrointestinal bleeding is a rare but serious manifestation.
Observation:
- A 4-year-old boy presented with abdominal pain, fever, rash, and gastrointestinal hemorrhage.
- The patient was diagnosed with complete Kawasaki disease.
- The child recovered well after standard treatment without complications.
Findings:
- Kawasaki disease can manifest with severe gastrointestinal bleeding, even in the absence of typical KD symptoms.
- Abdominal pain and fever in children warrant consideration for Kawasaki disease, especially when accompanied by gastrointestinal bleeding.
- Prompt diagnosis and management of KD are essential to prevent severe complications like cardiac issues.
Implications:
- Clinicians should consider Kawasaki disease in children with unexplained fever and abdominal symptoms, including gastrointestinal bleeding.
- Awareness of rare KD presentations like gastrointestinal hemorrhage is vital for timely diagnosis and treatment.
- Early recognition and intervention in Kawasaki disease can prevent long-term sequelae, particularly cardiovascular complications.
Background:
Kawasaki disease (KD) is an acute febrile multisystem vasculitis and has been recognized to be the most common cause of acquired heart disease in children. Owing to its propensity to involve vessels throughout the entire body, KD often mimics other disease processes. The diagnosis might be delayed if other prominent symptoms appear before the characteristic clinical features of KD. Although gastrointestinal symptoms including vomiting, diarrhea, and abdominal pain are not uncommon in KD patients, KD with gastrointestinal bleeding is quite rare.
Case Presentation:
A previously healthy 4-year-old boy initially presented with abdominal pain, followed by fever, rash, and gastrointestinal hemorrhage, eventually diagnosed as complete KD. The patient recovered smoothly after appropriate management and no subsequent complications occurred in the following months.
Conclusion:
The diagnosis of KD should be considered in children presenting with abdominal symptoms and fever without definable cause. Pediatricians should be aware of the risk of gastrointestinal bleeding in patients with KD, especially in those with prominent abdominal symptoms.
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