Atypically Protracted Course of Liver Involvement in Kawasaki Disease. Case Report and Literature Review

Hypertransaminasemia in patients with Kawasaki disease (KD) is reported to be transient. Here, we describe a child with an atypically protracted course of liver tests abnormalities and review the inherent literature. The patient was hospitalized at age 7-months for isolated hypertransaminasemia dete...

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Main Authors: Pamela Paglia, Lucia Nazzaro, Anna Giulia Elena De Anseris, Milena Lettieri, Rossella Colantuono, Maria Chiara Rocco, Maria Anna Siano, Nicola Biffaro, Pietro VAJRO
Format: Article
Language:English
Published: MDPI AG 2021-07-01
Series:Pediatric Reports
Subjects:
Online Access:https://www.mdpi.com/2036-7503/13/3/44
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spelling doaj-78b954802e8d44bea4e1fe598cc7746b2021-09-26T00:55:05ZengMDPI AGPediatric Reports2036-75032021-07-01134435736210.3390/pediatric13030044Atypically Protracted Course of Liver Involvement in Kawasaki Disease. Case Report and Literature ReviewPamela Paglia0Lucia Nazzaro1Anna Giulia Elena De Anseris2Milena Lettieri3Rossella Colantuono4Maria Chiara Rocco5Maria Anna Siano6Nicola Biffaro7Pietro VAJRO8Chair of Pediatrics and Residency Program of Pediatrics, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, ItalyPediatrics Units of San Giovanni di Dio e Ruggi d’Aragona University Hospital, 84131 Salerno, ItalyPediatrics Units of San Giovanni di Dio e Ruggi d’Aragona University Hospital, 84131 Salerno, ItalyChair of Pediatrics and Residency Program of Pediatrics, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, ItalyChair of Pediatrics and Residency Program of Pediatrics, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, ItalyChair of Pediatrics and Residency Program of Pediatrics, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, ItalyChair of Pediatrics and Residency Program of Pediatrics, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, ItalyChair of Pediatrics and Residency Program of Pediatrics, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, ItalyChair of Pediatrics and Residency Program of Pediatrics, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, ItalyHypertransaminasemia in patients with Kawasaki disease (KD) is reported to be transient. Here, we describe a child with an atypically protracted course of liver tests abnormalities and review the inherent literature. The patient was hospitalized at age 7-months for isolated hypertransaminasemia detected during a classical KD diagnosed 3 months before, and persistent since then. KD clinical evolution had been favorable, with rapid response to acetylsalicylic acid and intravenous immunoglobulins. Liver enzymes however remained persistently elevated with a fluctuating pattern (ALT > AST levels; peak of AST 186 IU/L and ALT 240 IU/L). During follow-up, the main causes of liver dysfunction had to be excluded through appropriate and extensive laboratory investigations. Transaminases values become steadily normal only 7 months after the acute presentation of KD. Conclusions: Our report shows that an atypically protracted courses of KD-related hypertransaminasemia above the previously reported temporal limits should be taken into account during the stepwise diagnostic approach to the patient’s liver dysfunction. Insidious acetylsalycilic acid-hepatotoxicity warrants consideration in the differential diagnosis.https://www.mdpi.com/2036-7503/13/3/44Kawasaki diseasepersistent hypertransaminasemiacase reportliterature review
collection DOAJ
language English
format Article
sources DOAJ
author Pamela Paglia
Lucia Nazzaro
Anna Giulia Elena De Anseris
Milena Lettieri
Rossella Colantuono
Maria Chiara Rocco
Maria Anna Siano
Nicola Biffaro
Pietro VAJRO
spellingShingle Pamela Paglia
Lucia Nazzaro
Anna Giulia Elena De Anseris
Milena Lettieri
Rossella Colantuono
Maria Chiara Rocco
Maria Anna Siano
Nicola Biffaro
Pietro VAJRO
Atypically Protracted Course of Liver Involvement in Kawasaki Disease. Case Report and Literature Review
Pediatric Reports
Kawasaki disease
persistent hypertransaminasemia
case report
literature review
author_facet Pamela Paglia
Lucia Nazzaro
Anna Giulia Elena De Anseris
Milena Lettieri
Rossella Colantuono
Maria Chiara Rocco
Maria Anna Siano
Nicola Biffaro
Pietro VAJRO
author_sort Pamela Paglia
title Atypically Protracted Course of Liver Involvement in Kawasaki Disease. Case Report and Literature Review
title_short Atypically Protracted Course of Liver Involvement in Kawasaki Disease. Case Report and Literature Review
title_full Atypically Protracted Course of Liver Involvement in Kawasaki Disease. Case Report and Literature Review
title_fullStr Atypically Protracted Course of Liver Involvement in Kawasaki Disease. Case Report and Literature Review
title_full_unstemmed Atypically Protracted Course of Liver Involvement in Kawasaki Disease. Case Report and Literature Review
title_sort atypically protracted course of liver involvement in kawasaki disease. case report and literature review
publisher MDPI AG
series Pediatric Reports
issn 2036-7503
publishDate 2021-07-01
description Hypertransaminasemia in patients with Kawasaki disease (KD) is reported to be transient. Here, we describe a child with an atypically protracted course of liver tests abnormalities and review the inherent literature. The patient was hospitalized at age 7-months for isolated hypertransaminasemia detected during a classical KD diagnosed 3 months before, and persistent since then. KD clinical evolution had been favorable, with rapid response to acetylsalicylic acid and intravenous immunoglobulins. Liver enzymes however remained persistently elevated with a fluctuating pattern (ALT > AST levels; peak of AST 186 IU/L and ALT 240 IU/L). During follow-up, the main causes of liver dysfunction had to be excluded through appropriate and extensive laboratory investigations. Transaminases values become steadily normal only 7 months after the acute presentation of KD. Conclusions: Our report shows that an atypically protracted courses of KD-related hypertransaminasemia above the previously reported temporal limits should be taken into account during the stepwise diagnostic approach to the patient’s liver dysfunction. Insidious acetylsalycilic acid-hepatotoxicity warrants consideration in the differential diagnosis.
topic Kawasaki disease
persistent hypertransaminasemia
case report
literature review
url https://www.mdpi.com/2036-7503/13/3/44
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