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Jaundice-predominant manifestation of Kawasaki disease in children
Ya-Ning Huang1,2, Chien-Yu Lin1,2,3, Hsin Chi3,4
1Department of Pediatrics, Hsinchu Municipal MacKay Children's Hospital, Hsinchu, Taiwan.
Insights
Kawasaki disease (KD) with jaundice is rare but linked to higher risks of treatment resistance, coronary artery issues, and recurrent episodes. Doctors should monitor these children for potential shock.
Area of Science:
- Pediatrics
- Immunology
- Gastroenterology
Background:
- Kawasaki disease (KD) is a critical pediatric illness, typically presenting with fever and rash.
- A jaundice-predominant presentation of KD is uncommon and may indicate atypical disease progression.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of children with Kawasaki disease presenting with jaundice.
- To identify potential risk factors and complications associated with this atypical KD presentation.
Main Methods:
- Retrospective review of 12 pediatric patients with jaundice-predominant KD at MacKay Children's Hospital.
- Analysis of 42 previously reported cases of jaundice-predominant KD in the literature since 1990.
Main Results:
- Patients exhibited elevated liver function, gallbladder hydrops, and gastrointestinal symptoms.
- Significant rates of intravenous immunoglobulin (IVIG)-refractory disease (33.3% in-house, 25% literature), coronary artery abnormalities (58.3% in-house, 25% literature), and shock (25% in-house, 13.2% literature) were observed.
- Recurrent KD episodes occurred in 16.7% of patients.
Conclusions:
- Jaundice-predominant KD is associated with increased risk of IVIG-refractory disease, coronary artery abnormalities, and recurrent episodes.
- Physicians must maintain a high index of suspicion for KD in jaundiced children and be vigilant for complications like shock.
Background:
A jaundice-predominant presentation of Kawasaki disease (KD) is atypical.
Methods:
A total of 12 children with KD with a predominant manifestation of jaundice at MacKay Children's Hospital were reviewed, along with 42 cases reported in the literature since 1990.
Results:
The median age of the 12 patients was 1.85 years (range: 3 months-4 years), and 66.6% were male. All of the patients had elevated liver function at presentation, 50% had hydrops of the gallbladder, and almost 60% had gastrointestinal symptoms and signs. Complete KD was evident in 11 of the 12 patients (91.7%), and two patients (16.7%) had recurrent episodes. All of the patients received intravenous immunoglobulin (IVIG); however, one-third were refractory to treatment. Corticosteroids were used in five (41.7%) of the patients. Three (25%) of the patients had shock, and seven (58.3%) had coronary artery abnormalities, of whom one (8.3%) had persistent coronary artery aneurysm and the others recovered. A review of the 42 cases in the literature showed that the children with a jaundice-predominant presentation of KD had high rates of IVIG-refractory disease (25%), coronary artery abnormalities (25%), shock (13.2%), and corticosteroid treatment (24.2%).
Conclusions:
Children with KD presenting with a jaundice-predominant manifestation are at a higher risk of IVIG-refractory disease, coronary artery abnormalities, and more recurrent episodes. Physicians should be aware of the risk of shock in this population.
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