SHM Converge Scientific Abstract ePoster Gallery-Not Your Average Crash and Burn: An Atypical Kawasaki Presentation

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This case describes a 9-year-old boy with a history of congenital Horner’s syndrome who presented with two weeks of cough, congestion, sore throat, pruritic rash, right upper quadrant abdominal pain, low-grade fever, and a brief episode of nausea and vomiting. On exam, he had mucositis with erythematous oral findings, maculopapular truncal rash, bilateral inguinal lymphadenopathy, palm and sole edema, tachycardia, and RUQ tenderness with a positive Murphy’s sign. Laboratory studies showed elevated inflammatory markers (ESR, CRP), cholestatic/hepatitic abnormalities, and elevated bilirubin. Infectious workup, including strep, EBV, CMV, monospot, COVID testing, and blood cultures, was negative. RUQ ultrasound showed gallbladder sludge and distention consistent with gallbladder hydrops. Echocardiogram showed normal coronary arteries.<br /><br />Although Kawasaki disease typically affects children under 5 years old, this patient had features concerning for atypical Kawasaki disease, including mucosal changes, rash, extremity edema, fever, lymphadenopathy, elevated inflammatory markers, and gallbladder hydrops. Because Kawasaki disease can present in unusual ways and delayed treatment increases the risk of coronary artery complications, IVIG and aspirin were started without delay. The patient was discharged with cardiology follow-up.<br /><br />The key teaching points are to recognize both classic and atypical signs of Kawasaki disease, consider it in older children, and remember that gallbladder hydrops can be an unusual manifestation. Early diagnosis and treatment are essential to prevent cardiac sequelae.

Asset Subtitle

Rachel H. Bharwani

Meta Tag

Author List Kelly E. Miller, Rachel H. Bharwani, Tariq Chaudry

Category Clinical Vignettes

Concept Kawasaki Disease

Concept Mucocutaneous Findings

Concept Lymphadenopathy

Concept Atypical Presentation

Concept Gallbladder Hydrops

Distinguished Non-Finalist

Presenter Organization University of Kentucky

Presenting Author Rachel H. Bharwani

Track Pediatric

Keywords

Kawasaki disease

atypical Kawasaki

gallbladder hydrops

mucositis

maculopapular rash

extremity edema

elevated inflammatory markers

cholestatic hepatitis

IVIG treatment

coronary artery complications

Kawasaki Disease

Mucocutaneous Findings

Lymphadenopathy

Atypical Presentation

Gallbladder Hydrops