Botti Matteo, Costagliola Giorgio, Consolini Rita
Section of Pediatrics Immunology and Rheumatology, Department of Pediatrics, University of Pisa, Pisa, Italy.
Front Pediatr. 2018 Apr 11;6:90. doi: 10.3389/fped.2018.00090. eCollection 2018.
We describe the case of a 3-year child in which pancreatic and parotid gland involvement preceded the development of the classical clinical phenotype of a typical Kawasaki disease (KD). The child was referred to the Emergency Department with a story of 3 days of continuous fever associated with abdominal pain and bilaterally swelling in the parotid regions; laboratory evaluation identified markedly increased levels of total amylase, pancreatic amylase, lipase, and transaminase, and diagnosis of pancreatitis was posed. After 9 days of fever and persistence of the clinical features, the classical signs of KD appeared, and the child was treated with intravenous immunoglobulins (IVIG), showing a dramatic response with complete resolution of the clinical picture. In this work, we reviewed the literature about gastrointestinal (GI) symptoms in KD, focusing on pancreatic and hepatic involvement. This analysis highlighted that, in case of fever associated with pancreatic inflammation, KD must be considered in the spectrum of differential diagnosis, and that GI involvement in KD is frequently associated with an incomplete response to IVIG treatment.
我们描述了一名3岁儿童的病例，其胰腺和腮腺受累先于典型川崎病（KD）经典临床表型的出现。该患儿因持续发热3天并伴有腹痛及双侧腮腺区肿胀被送往急诊科；实验室检查发现总淀粉酶、胰腺淀粉酶、脂肪酶和转氨酶水平显著升高，诊断为胰腺炎。发热9天后临床症状持续存在，KD的经典体征出现，患儿接受静脉注射免疫球蛋白（IVIG）治疗，临床症状完全缓解，反应显著。在这项研究中，我们回顾了关于KD胃肠道（GI）症状的文献，重点关注胰腺和肝脏受累情况。该分析强调，在伴有胰腺炎症的发热病例中，鉴别诊断范围必须考虑到KD，并且KD的胃肠道受累常与IVIG治疗反应不完全相关。
