A child of Kawasaki disease complicated with cholestasis and aseptic meningitis

doi:10.3877/cma.j.issn.1674-1358.2023.01.010

Abstract

Abstract:

Objective

To analyze a case of Kawasaki disease complicated with cholestasis and aseptic meningitis, and to raise the attention to the rare complications of Kawasaki disease.

Methods

The clinical data, diagnosis and treatment process and prognosis of a child with Kawasaki disease complicated with cholestasis and aseptic meningitis admitted to Xi’an Children’s Hospital on August 9th 2021 were analyzed, retrospectively.

Results

After admission, blood cell analysis showed that leukocytes (25.12 × 10⁹/L) increased, neutrophil ratio 85.6%, C-reactive protein (CRP) 159 mg/L, ESR 77 mm/h, total bilirubin (150.3 μmol/L) and direct bilirubin (117.4 μmol/L) increased significantly, alanine aminotransferase (78 IU/L) and aspartate aminotransferase (68 IU/L) increased slightly, total bile acids (143 μmol/L) increased. Abdominal CT showed a significant increase in the volume of gallbladder and no significant expansion of bile duct. Echocardiography showed bilateral coronary artery dilatation. Cerebrospinal fluid examination showed that the pressure increased slightly, and cerebrospinal fluid cytology, sugar and chloride were normal. Brain magnetic resonance imaging (MRI) and electroencephalogram (EEG) were normal. The patient was diagnosed as Kawasaki disease with cholestasis and aseptic meningitis. After treatment with intravenous gamma globulin 2 g/kg for anti-inflammation, aspirin and dipyridamole anticoagulation and inhibition of platelet aggregation, ademetionine for promoting jaundice regression, mannitol for cranial pressure reduction, the temperature returned normal, jaundice subsided, and his spirit was normal. After reexamination, all indicators recovered to normal without sequelae.

Conclusions

Kawasaki disease complicated with cholestasis and aseptic meningitis is rare, which is easy to be misdiagnosed and delayed to receive treatment. Therefore, clinicians are reminded to be alert to Kawasaki disease for children with cholestasis and/or aseptic meningitis and unexplained fever for longer than 5 days. Early diagnosis and timely treatment can reduce the complications of Kawasaki disease.

Key words: Kawasaki disease, Cholestasis, Aseptic meningitis, Complication

Yufeng Zhang, Pengfei Xu, Tiantian Tang, Ruiqing Liu, Han Wan. A child of Kawasaki disease complicated with cholestasis and aseptic meningitis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2023, 17(01): 60-64.

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References 28

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指标	治疗前	治疗后	参考范围
血红蛋白（g/L）	114	122	120~140
白细胞计数（× 10⁹/L）	25.12	9.3	4~12
中性粒细胞比率（%）	85.6	53.2	31~70
淋巴细胞比率（%）	10.2	37.9	25~59
血小板计数（× 10⁹/L）	268	776	100~300
C-反应蛋白（mg/L）	159	9.5	0~10
红细胞沉降率（mm/h）	77	40	0~22
总蛋白（g/L）	59.5	63.5	57~80
白蛋白（g/L）	35.9	38.5	37~51
总胆红素（μmol/L）	150.3	19.5	3.4~20.5
直接胆红素（μmol/L）	117.4	7.8	0~6.8
丙氨酸氨基转移酶（IU/L）	78	32	10~35
天冬氨酸氨基转移酶（IU/L）	68	34	10~35
总胆汁酸（μmol/L）	143	15	0~10

指标	治疗前	治疗后	参考范围
血红蛋白（g/L）	114	122	120~140
白细胞计数（× 10⁹/L）	25.12	9.3	4~12
中性粒细胞比率（%）	85.6	53.2	31~70
淋巴细胞比率（%）	10.2	37.9	25~59
血小板计数（× 10⁹/L）	268	776	100~300
C-反应蛋白（mg/L）	159	9.5	0~10
红细胞沉降率（mm/h）	77	40	0~22
总蛋白（g/L）	59.5	63.5	57~80
白蛋白（g/L）	35.9	38.5	37~51
总胆红素（μmol/L）	150.3	19.5	3.4~20.5
直接胆红素（μmol/L）	117.4	7.8	0~6.8
丙氨酸氨基转移酶（IU/L）	78	32	10~35
天冬氨酸氨基转移酶（IU/L）	68	34	10~35
总胆汁酸（μmol/L）	143	15	0~10

脑脊液指标	结果	参考范围
压力（mmH₂O）	220	40~100
蛋白质（mg/L）	394	200~400
葡萄糖（mmol/L）	3.29	2.8~4.5
氯化物（mmol/L）	123.5	117~127
白细胞总数（× 10⁶/L）	0	0~15
革兰染色	阴性	阴性
墨汁染色	阴性	阴性
CSF培养	阴性	阴性

脑脊液指标	结果	参考范围
压力（mmH₂O）	220	40~100
蛋白质（mg/L）	394	200~400
葡萄糖（mmol/L）	3.29	2.8~4.5
氯化物（mmol/L）	123.5	117~127
白细胞总数（× 10⁶/L）	0	0~15
革兰染色	阴性	阴性
墨汁染色	阴性	阴性
CSF培养	阴性	阴性

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