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Kawasaki Disease and the Pediatric Gastroenterologist: A Diagnostic Challenge

Eladawy, Mohammed; Dominguez, Samuel R.; Anderson, Marsha S.; Glodé, Mary P.

Erratum

In the article that published in the March 2013 issue on page 297, Dr Eladawy's affiliation with Ain Shams University was omitted.

Journal of Pediatric Gastroenterology and Nutrition. 59(3):340, September 2014.

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3182794432
Original Articles: Gastroenterology
Abstract

Background and Objectives: Gastrointestinal symptoms and signs are rarely the main clinical presentation of Kawasaki disease (KD). In the present study, we report a series of patients with KD in whom a gastroenterology consult was obtained before consideration of the diagnosis of KD.

Methods: We retrospectively reviewed all patients with KD admitted to Children's Hospital Colorado from January 2009 through February 2011 with prominent gastrointestinal symptoms, resulting in gastrointestinal service consultation before their diagnosis of KD.

Results: We identified 7 of 118 (6%) patients with KD who met our criteria. All 7 patients were males, and the median age at admission was 9.7 years. All patients had abdominal pain and fever at presentation. Vomiting, diarrhea, and clinical jaundice were present in 70%, 50%, and 43% of patients, respectively. Aminotransferases and/or γ-glutamyl transpeptidase abnormalities were observed in 6 (89%) patients. All of the patients had fever and rash on admission, and 86% had nonexudative conjunctivitis and 71% had mucosal changes. Median duration of illness at gastroenterology consultation was 5 days, whereas median duration of illness at infectious disease consultation was 6 days. One patient developed coronary artery dilation and 2 patients had intravenous immunoglobulin-resistant KD.

Conclusions: Gastroenterologists should be aware of gastrointestinal presentations of KD. Unexplained gastrointestinal symptoms in the presence of fever, and 1 or 2 of the major clinical signs of KD, should prompt consideration of KD in the differential diagnosis.

Author Information

Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital, Aurora, Colorado.

Address correspondence and reprint requests to Mohammed Eladawy, MD, PhD, Children's Hospital Colorado, Section of Pediatric Infectious Diseases, 13123 E 16th Ave, B055, Aurora, CO 80045 (e-mail: mohammed.eladawy@childrenscolorado.org).

Received 15 December, 2011

Accepted 15 October, 2012

The authors report no conflicts of interest.

Copyright 2013 by ESPGHAN and NASPGHAN