2024/12/31 by Khlayfia, Z., Azzabi, O., Ben Hfaiedh, J. +7
#Kawasaki disease - Gallbladder hydrop– Child - Infant #Maladie de Kawasaki – hydrocholécyste – Enfant - Nourrisson
paper · doi:10.71566/pist-rmp-194659
Introduction : Kawasaki disease is an acute multisystem vasculitis affecting medium-sized vessels with a predilection for coronary arteries. Sometimes the clinical presentation is atypical, leading to a misdiagnosis and delaying treatment. Objective : We report the case of a girl with Kawasaki disease revealed by an abdominal mass who was admetted and followed up in the pediatric department of Mongi Slim La Marsa hospital in 2022. Observation : Girl aged 8 years, issued from non-consanguineous marriage, with no particular family or per- sonal history having a normal psychomotor development and normal growth, consulted for fever progres- sing for 8 days with rapidly spreading rash and painful swelling of the right upper abdominalquadrant. She was fevrerish at 38. 8°C, eupneic with stable hemo- dynamic constants and good neurological status. She had a subicterus with a rash of erythematous macules and papules on her trunk and back. The tongue was raspberry. The abdominal examination showed: hepatomegaly, tenderness of the right hy- pochondrium and a painful and mobile mass mea- suring 10 cm in long axis without splenomegaly or adenomegaly. She had an inflammatory syndrome, thrombocytosis, hepatic cytolysis, cholestasis wi- thout hepatocellular insufficiency. Fibrinogen le- vels and D-Dimers were elevated. Hepatitis A, B, EBV, and COVID-19 serologies were negative. Ab- dominal ultrasonography showed an image of a Gallbladder hydrop without stones or dilated bile ducts. Echocardiography and chest x-ray were nor- mal. Kawasaki disease was strongly suspected and the child received polyvalent immunoglobulins at the dose of 2 g/kg, acetylsalicylic acid (Aspégic®) at an anti-inflammatory dose and then at an an- ti-aggregation dose, Ursodeoxycholic acid (Ursol- van®) and vitamin K. Evolution was characterized by rapid apyrexia with progressive normalization of liver function tests and disappearance of biological inflammatory syndrome and Gallbladder hydrop. Conclusion : Kawasaki disease is one of the main causes of Gallbladder hydrop in children. The Dia- gnosis should be considered in any mass of the right hypochondrium especially in association with prolonged fever and rash.