Intestinal Pseudo-Obstruction as the Presenting Manifestation of Kawasaki Disease

Excerpt

To the Editor: A 1.7-y-old previously healthy girl, presenting with a 4-d history of fever accompanied by cough and maculopapular rash, was admitted to our hospital. On admission, she was noted to have dry, fissured lips, bilateral conjunctivitis and edema of hands and feet. Later the clinical picture got complicated with mild abdominal distension along with significant decrease of bowel sounds, repeated vomiting and diarrhea. An abdominal ultrasound demonstrated intestinal gas accumulation (Fig. 1). A plain X-ray abdomen revealed partial intestinal dilatation and multiple fluid and gas levels in the intestine (Fig. 2). A diagnosis of intestinal pseudo-obstruction was made because of abdominal distension without signs of mechanical obstruction or perforation. Blood examinations showed WBC 13 × 10⁹/L (neutrophils 72.7%), platelets 331 × 10⁹/L, C-reactive protein (CRP) 96.1 mg/L, and ESR 49 mm/h. Fecal occult blood test was positive, whereas blood pressure, urea, creatinine, serum electrolytes, transaminases and urinalysis were all normal. On day 2, in light of prolonged fever (> 5 d), conjunctivitis, rash, edema of hands and feet, and cheilitis, a diagnosis of Kawasaki disease (KD) was made. On day 3, intravenous immunoglobulin at a dose of 400 mg/kg was initiated for three days, along with aspirin (50 mg/kg/d). Later the abdominal symptoms disappeared. Plain abdominal X-ray showed disappearance of intestinal dilatation and fluid and gas levels. Repeat fecal occult blood test was negative. On day 6, periungual desquamation of fingers and toes appeared. Repeated blood examinations showed decreased CRP and ESR, normalised WBC and mild thrombocytosis (Platelets: 486 × 10⁹/L). Subsequent echocardiography and electrocardiography were normal. She was discharged on day 9 in a stable condition on low-dose aspirin (5 mg/kg/d).

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