Abdominal lymphadenopathy in an adolescent with Kawasaki disease: a major sign?

Danielle Bulkool, Ana Vidal de Carvalho, Aurea Grippa, Marcia Fernandes, Israel Figueiredo
International Journal of Adolescent Medicine and Health 2016 July 21, 29 (6)
27442359
In adolescence, Kawasaki disease (KD) may present with varied clinical pictures, and the classic clinical criteria are often insufficient to establish the diagnosis. This report presents a clinical case of KD in an adolescent and a brief review of the relevant literature, based on a PubMed search using the terms "adolescence" and "KD". A 13-year-old girl presented with fever, rash, hepatomegaly, and ultrasonographic evidence of abdominal lymphadenopathy. On week 2 after onset of symptoms, the patient developed desquamation of the extremities and thrombocytosis. Echocardiography was normal during the acute illness and remained unchanged at 2-year follow-up. Clinicians should be aware that, in adolescents, KD poses a diagnostic challenge and rarely corresponds to the classic presentation. On retrospective analysis, we believe that abdominal lymphadenopathy should have been recognized as a substitute manifestation of the classic symptom of cervical lymphadenopathy to establish the diagnosis of this fearsome systemic vasculitis syndrome.

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