Kawasaki Disease and the Pediatric Gastroenterologist: A Diagnostic Challenge
Kawasaki Disease and the Pediatric Gastroenterologist: A Diagnostic Challenge
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DOI：
10.1097/mpg.0b013e3182794432
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发表时间：
2013-03-01
影响因子：
2.9
通讯作者：
Glode, Mary P.
中科院分区：
文献类型：
--
作者：
Eladawy, Mohammed;Dominguez, Samuel R.;Glode, Mary P.
背景和目的：胃肠道症状和体征很少是川崎病（KD）的主要临床表现。在本研究中，我们报告了一系列KD患者，他们在考虑诊断KD之前进行了胃肠病学咨询。方法：回顾性分析2009年1月至2011年2月在科罗拉多州儿童医院就诊的所有有明显胃肠道症状的KD患者，并在诊断为KD前进行胃肠服务咨询。结果：118例KD患者中有7例（6%）符合我们的标准。7例患者均为男性，入院时中位年龄9.7岁。所有患者就诊时均有腹痛和发热。呕吐、腹泻和临床黄疸分别出现在70%、50%和43%的患者中。在6例（89%）患者中观察到转氨酶和/或γ -谷氨酰转肽酶异常。所有患者入院时均有发热和皮疹，86%有非渗出性结膜炎，71%有粘膜改变。胃肠病学会诊的中位病程为5天，而传染病会诊的中位病程为6天。1例出现冠状动脉扩张，2例出现静脉免疫球蛋白抵抗性KD。结论：胃肠病学家应注意KD的胃肠道表现。伴有发热的不明原因胃肠道症状，以及KD的1或2个主要临床体征，在鉴别诊断时应考虑KD。
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 gamma-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.