Abnormal Presentation of Kawasaki Disease as Acute Cholecystitis

Introduction: Kawasaki disease is a common cause of pediatric vasculitis and the leading cause of acquired heart disease in the developed world. KD mainly occurs in young children and infants.

The clinical criteria include at least five days of fever plus at least 4 of 5 principal clinical features. Cardiac complications such as coronary artery aneurysm are the main concern of KD.

Case Report: A 19-month-old baby, with no medical history, was admitted to our hospital with symptoms for 4 days consisting of vomiting, fever up to 39 °C. On admission to the emergency department, he was hemodynamic stable but appears pale with mild jaundice in conjunctiva, in his examination redness in the conjunctiva, tongue and lips, impression of edema in the hands and legs, mild pain during palpitation in the upper right quadrant. Laboratory findings: Leukocytosis 16,000 mm3, Thrombocytes 400,000 platelets, hemoglobin 12 grams. Normal electrolyte and creatinine value, liver function showed mild abnormal results SGOT 180 units. GGT 80 units. Direct Bilirubin 4 mg/dl. Ferritin 280 . CRP 18. D-dimer10, Troponin, CPKA were normal. Blood and urine culture was normal, COVID-19 antibody was detected.

chest X-ray, ECG ,Cardiac Echo were normal. Abdominal ultrasound showed cholecystitis without stones in the gallbladder. CT showed a distended gallbladder.

The child was transferred to intensive care He was treated with steroids as a pulse with a gamma globulins, and aspirin treatment. All symptoms improved with treatment.

Conclusion: Our case is notable because of the irregular presentation of KD, fever beyond 4 days in addition to impaired liver function and enlarged inflammatory gallbladder without stones, everything supports the diagnosis of Kawasaki disease