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                                                                                                                                               ISSN 0973 - 0958
News Letter September- 2006
Dear Subscriber:

New features on www.pediatriconcall.com for this month:

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Query: My 9 year old daughter has been diagnosed and treated for Kawasaki syndrome a few weeks ago, but she continues to struggle with recurrent fevers, abdominal discomfort, and abnormal blood tests. Recent blood work showed: ESR=122, SGOT (AST)=44, GGT=63, SGPT (ALT)=120, Bilirubin=0.4 and Lipase=304. Although she had many classic signs of Kawasaki (fever, rash, peeling skin, swollen glands, jaundice), they question this diagnosis on the severe liver dysfunction, return of fever, severe abdominal pain, and nature of her blood work. She continues to have a high fever, and abnormal blood work that indicates inflammation. They now believe she has some other systemic cause of inflammation (irritable bowel syndrome, crohn's, JRA), but they're casting about. She's have an Upper GI w/follow-through but I sense her team doubts anything will be found. She is NOT having digestive difficulty. She also had an unexplained 8-day fever about 8 months ago that could be related, but we're just not sure. Your thoughts on the approach to diagnosis or other causes would be appreciated. Thanks.

Answer: Kawasaki 's is a clinical diagnosis with a conglomeration of various signs and symptoms. High ESR, raised CRP are signs of acute inflammation and may be seen in Kawasaki 's as well as other infections and autoimmune disorders. Thrombocytosis may be a predominant feature of Kawasaki 's. One may need to do 2 D echo of the heart to see if there is any evidence of coronary involvement. If yes, it would suggest Kawasaki 's and the child would require IVIg and aspirin immediately. Sometimes in Kawasaki 's the symptoms may recur and the disease process may become chronic requiring other drugs to control it. Hydrops of the gall bladder and hepatitis are also seen with Kawaski's disease. However, if in doubt one may rule out other autoimmune disorders.

 
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