Kawasaki Disease Presenting with Intestinal Pseudo-Obstruction

Excerpt

To the Editor: A 3-mo-old female infant presented with fever and bilious vomiting for 2 d. On examination, she was febrile with distended abdomen and decreased bowel sounds. X-ray abdomen revealed dilated bowel loops and serum potassium (4.9 mEq/L) was normal. As surgical causes were ruled out by ultrasonogram and surgeon’s opinion, a provisional diagnosis of septicemia with intestinal pseudo-obstruction (IPO) was considered and empirical antibiotics were administered. The next day, BCG vaccination site erythema (BCG-itis) was noted. Investigations revealed elevated C-reactive protein (4.8 mg/dl), erythrocyte sedimentation rate 100 mm/h, normocytic anemia (7.9 g/dl), leucocytosis (27 × 10⁹/L), thrombocytosis (604 × 10⁹/L), sterile pyuria (300 WBC/ HPF), hypoalbuminemia (2.8 g/dl). Blood and urine cultures were sterile. Echocardiogram on day 4 of illness revealed dilation of left main coronary artery and distal segment of right coronary artery with diameters of 2.5 mm (+3.08 Z score) and 1.7 mm (+3.00 Z score), confirming incomplete KD. She was treated with intravenous immunoglobulin (IVIG) and aspirin. Fever persisted even after 36 h of IVIG; resistant KD was diagnosed and IVIG was re-administered, following which defervescence occurred. Echocardiogram on day 14 and day 60 after illness revealed no residual coronary artery abnormalities (CAA). …