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Beyond the Atypical: Gastrointestinal Manifestations in Kawasaki Disease
Arwa Ahmed1, Amal Irfan Khazi1, Zaineb Benslimane2
1Pediatric Medicine, Al Qassimi Women's and Children's Hospital, Sharjah, ARE.
Insights
Atypical Kawasaki disease (KD) in infants presents diagnostic challenges, often delaying critical treatment for coronary artery issues. Early recognition of varied symptoms is vital to prevent severe cardiovascular complications.
Area of Science:
- Pediatric Rheumatology
- Infectious Diseases
- Cardiovascular Medicine
Background:
- Kawasaki disease (KD) is a primary cause of acquired heart disease in children, characterized by systemic vasculitis.
- Coronary artery abnormalities are the most significant complication, potentially leading to aneurysms and long-term cardiovascular issues.
- Atypical presentations of KD can mimic other common childhood illnesses, complicating early diagnosis.
Observation:
- A six-month-old unvaccinated infant presented with prolonged fever, vomiting, and diarrhea, initially misdiagnosed.
- Diagnostic delays occurred due to the absence of classic KD symptoms, necessitating extensive investigations.
- Echocardiography revealed coronary artery and aortic root dilation, leading to an atypical KD diagnosis.
Findings:
- Delayed diagnosis of atypical Kawasaki disease in infants can lead to severe coronary artery complications.
- Prompt treatment with intravenous immunoglobulin and aspirin significantly improved the patient's condition.
- This case underscores the challenges in diagnosing KD in very young children with non-specific symptoms.
Implications:
- Increased clinical awareness of atypical Kawasaki disease symptoms in infants is crucial for timely diagnosis and treatment.
- Early recognition and intervention are essential to mitigate the risk of irreversible cardiovascular damage.
- Healthcare providers must consider Kawasaki disease in infants presenting with prolonged fever and gastrointestinal or respiratory symptoms.
Abstract:
Kawasaki disease (KD) is an acute vasculitis mainly seen in children, with a specific risk for coronary artery involvement. Atypical symptoms can sometimes result in missed diagnoses, delaying necessary treatment and increasing the chances of serious cardiovascular complications. We report a case of a six-month-old previously healthy girl who had not been vaccinated. She presented with high fever, vomiting, and diarrhea for two weeks. The initial treatment for a suspected upper respiratory infection and later gastrointestinal issues created a diagnostic challenge. After many tests and scans over several weeks, a clear diagnosis was made only when an echocardiogram showed dilated coronary arteries and a dilated aortic root. She was then diagnosed with atypical KD and was given high doses of aspirin and intravenous immunoglobulins, resulting in substantial improvement in her condition. This case points out the difficulty in diagnosing KD in very young children, particularly when typical signs are missing. The delayed identification of KD led to serious complications, highlighting the importance of greater awareness among healthcare workers about atypical symptoms in infants. Quick action is vital to reduce the risk of severe cardiovascular consequences and to avoid delaying necessary treatment.
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