Acute Abdomen in Kawasaki Disease

Acute Abdomen in Kawasaki Disease: Case Reports

Clinical and histopathological description of three cases of Kawasaki disease with acute abdomen.

Study Overview

Status

Completed

Intervention / Treatment

Detailed Description

CASE PRESENTATION Case 1 An 8 year-old male started 48 hrs prior to admission with abdominal pain in the right lower quadrant associated with vomiting and fever. The physical examination revealed discrete bilateral conjunctival hiperemia, right cervical adenomegaly, and severe abdominal pain in the right lower quadrant with a positive McBurney sign. Laboratory tests showed CBC: Hb 14.1 g/dl, WBC 13,800, NT 81%, LT 3%, Plt 383,000/μl. C-reactive protein 230.9 mg/dl, BNP 106.4 pg/ml (0-99). Abdominal ultrasound confirmed the diagnosis of appendicitis. A laparoscopic appendectomy was performed, and appendiceal distal enlargement with fibrinopurulent tissue was found. Twelve hours after surgery, the patient presented increased conjunctival hyperaemia, generalized rash as well as upper extremities edema and desquamation, meeting criteria for Kawasaki disease. Cardiological evaluation showed mild pericardial effusion (3mm), normal coronary arteries. Intravenous immunoglobulins (IVIG), aspirin and steroids were started with resolution of the fever, rash and the conjunctival erythema.

Case 2. A 6-year-old male started 15 days prior to admission with fever. He presented hands and feet edema and a generalized exantema. He was diagnosed with scarlet fever. The patient presented conjunctival hyperemia and cheilitis. On day 15 the patient had severe abdominal pain (right lower quadrant), and was hospitalized with the diagnosis of appendicitis. An appendicetomy was performed and two perforations of the appendix were found. Appendicitis was found (Figure 1). The patient persisted with fever and desquamation of perineal area, fingers and toes were added to the clinical picture. Laboratories reported blood count: Hb 13 g/dl, WBC 47,700/mm3 neutrophils 95% bands 8% platelets 551,000/μl, C-reactive protein 19.7 mg/dl, ESR 53 mm/hr, hypoalbuminemia 2.2 g/dl. Diagnosis of KD was established and IVIG 2 g/kg and aspirin were administered. Echocardiogram was normal. Surgical wound culture was reported positive for Enterococcus faecium and Escherchia coli. Antibiotic therapy was administered for 14 days with good evolution.

Case 3. A 5-year-old male patient, presented with a history of fever for 5 days diagnosed as bacterial tonsillitis and treated with antibiotics without resolution. On the fifth day the patient developed bilateral conjunctivitis, erythema on the lips, morbilliform exanthema in the anterior and posterior thorax and abdominal pain in mesogastrium and right lower cuadrant. His physical examination revealed non-purulent bilateral conjunctivitis, cracked lips, strawberry tongue, cervical lymphadenopathy of 0.5 x 1 cm, exanthema in thoracic and dorsal region, with significant erythema of palms and soles, without skin exfoliation. The patient presented with severe abdominal pain located in the right lower quadrant, with signs of peritoneal irritation. Abdominal ultrasound was performed and was suggestive of acute appendicitis. Laboratories reported blood count: Hb 14.1 g/dl, Hcto 40.5%, WBC 3400 /uL, neutrophils 3100/uL, lymphocytes 300 103/uL, platelets 41,000 103/uL; ferritin 1700 ng/ml, triglycerids 190 mg/dl, C-reactive protein 8 mg/dl, normal hepatic and renal function. A diagnosis of KD and acute appendicitis was made. Treatment was started with IVIG and aspirin. The boy was taken to diagnostic laparoscopy where periappendicular inflammation was found. The cecal appendix biopsy presented normal morphology up to the serous layer, with congestive vessels, interstitial edema, and mild inflammatory infiltrate with predominantly mononuclear cells within the lymphatic vessels (Figure 2). A final diagnosis of mild mononuclear periappendicitis was made. The patient had an uneventful evolution with resolution of the symptoms.

Study Type

Observational

Enrollment (Actual)

3

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

1 year to 16 years (Child, Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Kawasaki disease patients

Description

Inclusion Criteria:

  • Patients with Kawasaki disease.
  • Acute abdomen requiring surgery.

Exclusion Criteria:

  • Patients with chronic gastrointestinal disease.
  • Incomplete data on the charts.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Case-Only
  • Time Perspectives: Retrospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Kawasaki disease presenting with acute abdomen
Time Frame: Up to three weeks
Histopathological results of appendix
Up to three weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 14, 2016

Primary Completion (Actual)

February 15, 2019

Study Completion (Actual)

February 15, 2019

Study Registration Dates

First Submitted

March 31, 2019

First Submitted That Met QC Criteria

April 2, 2019

First Posted (Actual)

April 4, 2019

Study Record Updates

Last Update Posted (Actual)

April 4, 2019

Last Update Submitted That Met QC Criteria

April 2, 2019

Last Verified

April 1, 2019

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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