A Rare Manifestation of Kawasaki Disease: Bloody Diarrhea Association with Acute Clinical Myocarditis
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Abstract
Kawasaki disease (KD) is a systemic vasculitis of small and medium-sized vessels that mainly influences children under five. In the classic diagnostic criteria of KD, there is no Gastrointestinal involvement. Myocarditis is one of the unusual cardiovascular complications of KD, and there is only a very minority of patients have symptoms suggestive of clinical myocarditis. Case Presentation: We reported a 7-year-old boy admitted with a high fever and bloody diarrhea. The stool exam revealed many white blood cells (WBCs) and red blood cells (RBCs). On the 5th day of admission, we found bilateral cervical lymphadenopathy, bilateral nonexudative conjunctivitis, cracked lips, and maculopapular rashes over the extremities. Echocardiography revealed severe mitral regurgitation (MR) with reduced ejection fraction (EF). We treated the patients with oral high-dose aspirin (100 mg/kg/d) plus intravenous immunoglobulin (IVIG 2 gr/kg). Cardiovascular complications such as acute clinical myocarditis should be highly suspected in any patient KD with persistent bloody diarrhea.
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[2] Ohnishi Y, Mori K, Inoue M, Satake N, Yano M. A case of Kawasaki disease presenting as sigmoid colitis. Journal of Medical Ultrason- ics. 2018; 45(2):381-4. [DOI:10.1007/s10396-017-0808-3] [PMID] [PMCID]
[3] Miyahara M, Hirayama M. Kawasaki disease resembling acute co- litis. BMJ Case Reports. 2013; 2013:bcr2012007384. [DOI:10.1136/ bcr-2012-007384] [PMID] [PMCID]
[4] Singh R, Ward C, Walton M, Persad R. Atypical Kawasaki disease and gastrointestinal manifestations. Paediatrics & Child Health. 2007; 12(3):235-7. [DOI:10.1093/pch/12.3.235] [PMID] [PMCID]
[5] Halimiasl A, Hosseini AH, Shiari R, Ghadamli P, Mojtahedzadeh S. Concomitant coronary artery aneurysm and myocarditis as a rare manifestation of kawasaki disease: A case report. Journal of Comprehensive Pediatrics. 1970; 3(1):34-6. [DOI:10.17795/com- preped-5209]
[6] Janiec I, Werner B, Sieminska J, Ravens-Sieberer U. Quality of life of children with mitral valve prolapse. Quality of Life Research. 2011; 20(4):537-41. [DOI:10.1007/s11136-010-9780-8] [PMID] [PMCID]
[7] Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Ka- wasaki disease: A statement for health professionals from the Com- mittee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004; 110(17):2747-71. [DOI:10.1161/01. CIR.0000145143.19711.78] [PMID]
[8] Ghandi Y, Habibi D, Kahbazi M, Dorreh F, Lotfi M. Clinical Charac- teristics of Kawasaki Disease in Markazi Province, Iran. Journal of Comprehensive Pediatrics. 2020; 11(1):e85695. [DOI:10.5812/com- preped.85695]
[9] Gidding SS. Late onset valvular dysfunction in Kawasaki disease. Progress in Clinical and Biological Research. 1987; 250:305-9. [PMID]
[10] Kato H, Sugimura T, Akagi T, Sato N, Hashino K, Maeno Y, et al. Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. Circulation. 1996; 94(6):1379-85. [DOI:10.1161/01.CIR.94.6.1379] [PMID][11] Ravekes WJ, Colan SD, Gauvreau K, Baker AL, Sundel RP, van der Velde ME, et al. Aortic root dilation in Kawasaki disease. The Ameri- can Journal of Cardiology. 2001; 87(7):919-22. [DOI:10.1016/S0002- 9149(00)01541-1]
[12] Bahrami M, Ghandi Y. Clinical and laboratory characteristics of kawasaki disease in Iran: A systematic review and meta-anal- ysis. International Journal of Pediatrics. 2020; 8(12):12659-73. [DOI:10.22038/IJP.2020.47265.3834]
[13] Ayusawa MAO, Miyashita T. The study of death cases in acute phase Kawasaki disease over the last 10 years based on a National Survey. Pediatric Cardiology and Cardiovascular Surgery. 2000; 20:245. https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5 &q=The+study+of+death+cases+in+acute+phase+Kawasaki+dise=
[14] Moran AM, Newburger JW, Sanders SP, Parness IA, Spevak PJ, Burns JC, et al. Abnormal myocardial mechanics in Kawasaki dis- ease: Rapid response to gamma-globulin. American Heart Journal. 2000; 139(2 Pt 1):217-23. [DOI:10.1067/mhj.2000.101221] [PMID]
[15] Yonesaka S, Takahashi T, Eto S, Sato T, Otani K, Ueda T, et al. Biopsy-proven myocardial sequels in Kawasaki disease with giant coronary aneurysms. Cardiology in the Young. 2010; 20(6):602 [DOI:10.1017/S1047951109991132] [PMID]
[16] McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, treatment, and long-term manage- ment of Kawasaki Disease: A scientific statement for health pro- fessionals from the American Heart Association. Circulation. 2017; 135(17):e927-9. [DOI:10.1161/CIR.0000000000000484] [PMID]
[17] Yoshikawa H, Nomura Y, Masuda K, Hazeki D, Yotsumoto K, Arata M, et al. Four cases of Kawasaki syndrome complicated with myo- carditis. Circulation Journal. 2006; 70(2):202-5. [DOI:10.1253/ circj.70.202] [PMID]
[18] Rached-D’Astous S, Boukas I, Fournier A, Raboisson MJ, Dahdah N. Coronary artery dilatation in viral myocarditis mimics coronary artery findings in Kawasaki Disease. Pediatric Cardiology. 2016; 37(6):1148-52. [DOI:10.1007/s00246-016-1411-x] [PMID]
| Files | ||
| Issue | Vol 6 No S1 (2021): Supplementary | |
| Section | Case Report(s) | |
| Keywords | ||
| Children Diarrhea Fever Myocarditis Kawasaki disease | ||
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How to Cite
1.
Ghandi Y, Sadjadei N, Mobinkhaledi M. A Rare Manifestation of Kawasaki Disease: Bloody Diarrhea Association with Acute Clinical Myocarditis. CRCP. 2022;6(S1):279-283.
