[Atypical Kawasaki disease with acute cholestasis and early coronary involvement at onset in an adolescent]

Area of Science:

• Pediatrics
• Cardiology
• Rheumatology

Background:

• Kawasaki disease is a primary cause of acquired heart disease in children.
• Diagnosis typically relies on established clinical criteria, but atypical presentations pose challenges.
• Delayed diagnosis increases the risk of coronary artery abnormalities.

Observation:

• A 13-year-old boy presented with atypical Kawasaki disease features, including febrile cholestasis and abdominal pain.
• Coronary anomalies were noted early in the disease course.
• The patient's age and initial presentation deviated from typical Kawasaki disease patterns.

Findings:

• The case highlights that Kawasaki disease can occur in older children and present with cholestatic jaundice.
• Early coronary anomalies were a key feature in this atypical presentation.
• Diagnostic delays were associated with the unusual clinical picture.

Implications:

• A high index of suspicion for Kawasaki disease is necessary in children with febrile cholestatic jaundice, regardless of age.
• Recognizing atypical Kawasaki disease presentations is vital for timely intervention.
• Prompt diagnosis and treatment can mitigate the risk of severe cardiac complications.