First Case of Terminal Ileitis Coexisting with Incomplete Kawasaki Disease

Öz

Kawasaki disease (KD), also referred to as mucocutaneous lymph node syndrome and infantile polyarteritis nodosa, is characterized by inflammation of small and medium-sized blood vessels across the body. It can manifest in various clinical features among pediatric patients admitted to general pediatric departments with fever, particularly those aged less than 5 years. Despite its relatively benign nature, it is crucial to promptly identify potential complications. We describe the case of a 10-month-old female patient admitted to the general pediatric department due to a 5-day history of fever peaking at 40.5⁰C, diarrhea, and irritability. Physical examination revealed no conjunctivitis, cervical lymphadenopathy, or rash, but notable irritability and edematous induration on the dorsum of her hands and feet. Initial laboratory investigations showed elevated acute phase reactants, and radiological assessment indicated terminal ileitis. Considering the presentation consistent with incomplete KD, characterized by persistent fever, ill appearance, ileitis, hypoalbuminemia, and elevated acute phase reactants, we pursued further evaluation. Echocardiography revealed ecstatic and prominent coronary artery without dilation of the main coronary arteries. It is important to recognize that not all KD patients will exhibit all typical features, and presentations may vary. While inflammatory changes in multiple systems have been documented in KD, terminal ileitis has not been previously reported in pediatric patients.

Anahtar Kelimeler

• Incomplete Kawasaki disease
• terminal ileitis
• persistent fever

Kaynakça

1. Son MB, Newburger JW. Kawasaki disease. In: Kliegman RM, Stanton BF, Geme JWSt III, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics, 19th edition. Philadelphia, Pa, USA: Elsevier; 2011. pp. 862-5. google scholar Takahashi K, Oharaseki T, Yokouchi Y. Pathogenesis of Kawasaki Disease. Clin Exp Immunol. 2011;164:20-2. google scholar
2. Burns JC, Mason WH, Glode MP, et al. Clinical and epidemiologic characteristics of patients referred for evaluation of possible Kawasaki disease. United States Multicenter Kawasaki Disease Study Group. J Pediatr. 1991;118:680-6. google scholar
3. Kato H, Sugimura T, Akagi T, et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation. 1996;94: 1379–1385. google scholar
4. Anderson BL, Guiot AB, Timm NL. An atypical presentation of atypical Kawasaki disease. Pediatr Emerg Care. 2014;30:491–492. google scholar
5. Newburger JW, Takahasi M, Gerber MA, et al. Diagnosis, treatment and long-term management of Kawasaki disease: a statement for health professionals from the Committee of Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110:2747–2771. google scholar
6. McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals from the American Heart Association. Circulation. 2017;135:e927. google scholar
7. Kim DH, Cheon JH. Intestinal Behcet’s Disease: A True Inflammatory Bowel Disease or Merely an Intestinal Complication of Systemic Vasculitis? Yonsei Med J. 2016;57:22–32. google scholar
8. Periyakaruppan M, Kumar S, Kandasamy S, et al. COVID abdomen: SARS-CoV-2 infection presenting as ’acute abdomen’ in a child. Crit Care Emerg Med. 2021;88:299–300. google scholar