Журнал сосудистой медицины и хирургии

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Kawasaki Disease with Intestinal Ischemia/Mucous Membrane Necrosis in a 16 Months Old Boy: A Case Report and literature Review

Xiao-Zhe Cui, Hong Wang

Background: Kawasaki Disease (KD) is a common vasculitis in children under 5 years old, and it may cause multiple system complications. In the case of the digestive system complication, KD can cause abdominal pain, diarrhea, hypoalbuminemia, liver damage, intussusception, cholecystitis, limit of peritonitis, and intestinal stenosis. So far there have been no reports on KD with bowel necrosis. Here, we report the first case of a KD patient with significant intestinal mucous membrane necrosis.

Case presentation: Patient is a 16 months old boy, presented with fever for five days, along with rashes, congestive conjunctiva, red and cracked lips, left cervical lymphadenopathy, edema on hands and feet for one day. He had vomiting, progression of abdominal distension, along with poor mental state and irritability for 2 days.

Physical examination: His abdomen was distended and the sounds of bowel movement were weakened. The boundary of pulmonary vs. liver was clears. Neck rigidity was observed. Abdominal DR showed the intestine at left side filled with fluid and gas. Ultrasound showed pneumatosis in liver around portal vein, dilated intestine, enlarged gallbladder, and stasis of bile in the gall bladder on Day 5 of illness. Abdominal enhanced CT showed hydronephrosis at the left kidney, dilated intestinal tube. Pneumatosis at the lower middle intestinal wall was detected on Day 7 of illness, but recovered almost normal on Day 10. He was diagnosed with KD complicated with extensive intestinal mucous membrane necrosis. He was treated with IVIG, oral aspirin, fasting, rehydration, short term of methylprednisolone, and anti-inflammatory drugs. There was no surgery intervention needed. He recovered without coronary artery damages.

Conclusion: In KD patients, severe intestinal necrosis at the acute stage can jeopardize patients’ lives. Here we report a case that a KD patient had digestive system involvement. Physical exam, lab tests, ultrasonic and CT tests suggested intestinal necrosis in mucosal layer. We provided comprehensive treatments immediately after the assessment. The patient recovered without the need of surgical intervention.