Department of Paediatrics, ShaoXing KeQiao Women And Children's Hospital, ShaoXing, 312030, Zhejiang Province, PR China.
BMC Infect Dis. 2021 May 4;21(1):415. doi: 10.1186/s12879-021-06101-y.
Kawasaki disease (KD) is the most common cause of acquired heart disease among children in developed countries, in which the resulting coronary artery (CA) abnormalities cause myocardial ischemia, infarction, and death. Prompt diagnosis was essential, and supplemental information should be used to assist the diagnosis when classical clinical criteria are incomplete. The elevated levels of serum transaminases in most KD patients are mild. Herein, a case of atypical KD child with severely elevated transaminase was reported.
A child with clinical manifestations of fever, high C-reactive protein (CRP) and severely elevated transaminases was reported. The treatment effect of antibiotic and liver-protecting drugs was not satisfactory. A bilateral diffuse dilation of the CA was detected on echocardiography on day 5 of the illness; thus, atypical KD was diagnosed. Elevated transaminases declined rapidly to normal after the treatment of intravenous immunoglobulin (IVIG). A 1-month follow-up revealed that CA returned to normal, and 2-month, 6-months, and 1-year follow-up revealed the child was in good general health.
This case highlighted that atypical KD clinical symptoms were diverse, and severely elevated transaminases might provide a clue to healthcare providers for the diagnosis and management of atypical KD.
川崎病（KD）是发达国家儿童获得性心脏病的最常见原因，其中导致的冠状动脉（CA）异常会引起心肌缺血、梗死和死亡。及时诊断至关重要，当经典临床标准不完整时，应使用补充信息协助诊断。大多数 KD 患者的血清转氨酶升高是轻度的。本文报告了一例转氨酶显著升高的不典型 KD 患儿。
报告了一例具有发热、高 C 反应蛋白（CRP）和转氨酶显著升高的临床表现的患儿。抗生素和保肝药物的治疗效果并不理想。在发病第 5 天，超声心动图检查发现双侧 CA 弥漫性扩张，因此诊断为不典型 KD。静脉注射免疫球蛋白（IVIG）治疗后，转氨酶迅速降至正常。1 个月随访时，CA 恢复正常，2 个月、6 个月和 1 年随访时患儿一般情况良好。
本病例强调了不典型 KD 临床表现多样，转氨酶显著升高可能为临床医生诊断和治疗不典型 KD 提供线索。
