Periodically, Kawasaki disease (KD) will present with fever and cholestasis (JPGN 2012; 55: 380-83).
The authors of this study which took place between 2003-2010 reviewed the presentation of children less than 16 years of age who presented with fever on admission (>38.5), total bilirubin >3 mg/dL and elevated ALT values. In all 24 patients who met criteria for review; 5 (21%) had KD. Patients with KD ranged in age between 1-10 years.
The other causes included viral hepatitis in 13 (EBV, HAV, CMV, Adenovirus, HSV), 4 had drug-induced cholestasis, 1 with cholelithiasis, and 1 with a choledochal cyst.
In almost 20% of KD patients, the presentation does not meet all of the diagnostic criteria: at least 5 days of fever and 4 of 5 following conditions: bilateral nonpurulent conjunctival injection, oral mucosal changes, peripheral extremity changes (edema/erythema of palms/soles, desquamation of fingers/toes), rash, cervical lymphadenopathy (unilateral, >1.5 cm).
Also, for those who did not receive yesterday’s blog on NASPGHAN postgraduate course, check out the following link:
- -J Pediatr 2011; 158: 644. Infliximab may work better than IVIG for Kawasaki.
- -J Pediatr 2009; 155: 695. Reviews recent experience & criteria for Kawasaki.
- -Pediatrics 2004; 114: 1708. guidelines from AAP for Kawasaki.